This week's BMJ contains two articles about the diagnosis and management of urinary tract infections in children.1 2 The first is a summary of the recently published guidelines from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and management of such infections.1 The second is a multicentre randomised controlled trial comparing exclusive oral antibiotic treatment with antibiotic treatment started parentally and completed orally in children with a first episode of acute pyelonephritis.3 What do these articles add to current knowledge about how best to diagnose and treat urinary tract infections in children?

The 1991, UK guidelines on acute urinary tract infections in childhood were prompted by the great variation in management of this condition.4 They emphasised that urinary tract infections and vesicoureteric reflux can cause scarred kidneys (reflux nephropathy), leading to hypertension and chronic renal failure. US guidelines also emphasised the need to diagnose, treat promptly, and investigate children with a confirmed urinary tract infection, especially those under 2 years of age who are at greatest risk of renal damage.5

Enthusiasm for extensively investigating children with urinary tract infections for vesicoureteric reflux has lessened with the finding of globally “scarred” kidneys due to dysplasia in infants born with antenatally detected urinary tract abnormalities, gross vesicoureteric reflux, and no urinary tract infection. In addition, the widespread use of dimercaptosuccinic acid renal …