New guidelines for complicated urinary tract infections in children

By Dr Emily Lathlean MB BS, FRACGP

New guidelines for the management of complicated urinary tract infections (UTIs) in children have been published by the European Society of Pediatric Infectious Diseases.

‘These are the first national or international guidelines specifically for complicated UTIs,’ said Associate Professor Penelope Bryant, first author of the guidelines, published in the Pediatric Infectious Disease Journal, and Paediatrician and Infectious Diseases Physician in the Department of Paediatrics at the University of Melbourne, Melbourne.

Professor Bryant, who is also Murdoch Children’s Research Institute Group Leader of Clinical Infections in Melbourne, said that UTIs were common in children and most were uncomplicated.

‘Almost 8% of girls and 2% of boys will have a UTI by the time they are 7 years old,’ she said. ‘Existing national and international guidelines [have previously] focused on uncomplicated UTIs... These new guidelines standardise how to diagnose complicated UTIs, the immediate management and follow up regarding the need for prophylaxis and [urology specialist] referral.’

The guidelines categorised children with complicated UTIs into five subgroups: children with known anatomical or functional urological abnormalities, children with recurrent UTIs, children with a severe clinical presentation, children with nonurological underlying conditions and neonates.

Professor Bryant said that the management of patients in these categories could be more complicated, and that treatment was more likely to fail if such patients were treated as per the usual treatments for uncomplicated UTIs.

‘Children with complicated UTIs need to be treated differently for several reasons, and although these overlap between subgroups, they are not the same for each group,’ she said. ‘These reasons include higher risks of infection complications, UTI recurrence and unusual or resistant bacteria,’ she noted.

‘This means that some children will need intravenous antibiotics, broader empirical changes and/or longer courses. Some will need additional investigations, and some will need specific follow up and [urology specialist] referral. All of these recommendations are clear in the new guidelines.’

The guidelines emphasised the importance of urinary samples to confirm the UTI diagnosis in all children before prescribing antibiotics, irrespective of whether the UTI was thought to be complicated or uncomplicated.

‘The guidelines include clear tables for management recommendations, are open access on the Pediatric Infectious Diseases Journal website (so they can be downloaded or bookmarked), and will be available in simplified form on the European Society for Pediatric Infectious Diseases website,’ Professor Bryant added. 

Pediatr Infect Dis J 2025; doi: 10.1097/ INF.0000000000004790.