A Systematic Review and Meta-Analysis of the Prevention and Management of Pediatric Urinary Tract Infection and Suspected Urinary Tract Infection: Technical Report

Urinary tract infection (UTI) is a common bacterial infection during childhood. This article reports on a technical review investigating the management of UTI to inform the development of an updated clinical practice guideline (CPG) by the American Academy of Pediatrics (AAP).

The authors performed 5 systematic reviews comparing different options for: 1) antibiotic duration in children without known anatomic anomalies; 2) antibiotic route in children without known anatomic anomalies; 3) use of continuous antibiotic prophylaxis (CAP) for children with vesicoureteral reflux (VUR); 4) use of CAP for children with bowel and bladder dysfunction (BBD); and 5) timing of evaluation of children with suspected UTI. We performed database searches of Medline via PubMed, Embase, and Cochrane library from January 1, 2008, through August 5, 2023. Eligible studies were published in English and compared management strategies in a population of children with UTI, suspected UTI, acute pyelonephritis, VUR, and/or BBD. Data on study characteristics and patient-important outcomes were extracted from studies and pooled using meta-analysis when appropriate. Risk of bias was assessed using the Prediction model of Risk Of Bias ASsessment Tool, the Risk of Bias in Nonrandomized Studies of Interventions, and version 2 of the Cochrane risk-of-bias tool for randomized trials. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.