Key messages

• Treating symptomatic acute urinary tract infection in children with an antibiotic is accepted clinical practice and trials would be considered unethical

• We found little evidence on the effects of delaying treatment while awaiting microscopy or culture results, but retrospective observational studies suggest delayed treatment may be associated with increased rates of renal scarring

• One systematic review of randomised controlled trials (RCTs) has found that antibiotic treatment for seven days or longer is more effective than shorter courses

• We found no convincing evidence of benefit from routine diagnostic imaging of all children with a first urinary tract infection, but subgroups at increased risk of future morbidity may benefit from investigation. Because such children cannot currently be identified clinically, investigating all young children with urinary tract infection may be warranted

• Two small RCTs found that prophylactic antibiotics prevented recurrent urinary tract infection in children, particularly during the period of prophylaxis. The long term benefits of prophylaxis have not been adequately evaluated, even for children with vesicoureteric reflux. The optimum duration of treatment is unknown

• One systematic review and a subsequent multicentre RCT found no difference between surgery for vesicoureteric reflux and medical management in preventing recurrence or complications from UTI