National collaborating centre for women’s and children’s health. NICE clinical guideline. Urinary tract infection in children. Diagnosis, treatment and long-term management. http://www.nice.org.uk/nicemedia/pdf/CG54fullguideline.pdf Accessed 23.09.14. RATIONALE: Diagnosis and referral: expert opinion is that children under the age of 3 months with suspected UTI should be admitted; that imaging during the acute episode is only needed for atypical UTI or for children under the age of 6 months with UTI. The guidance differentiates between lower UTI and upper UTI giving a definition as: Infants and children who have bacteriuria and either fever of 38°C or higher or loin pain/tenderness should be considered to have acute pyelonephritis/upper urinary tract infection. All other infants and children who have bacteriuria but no systemic symptoms or signs should be considered to have cystitis/lower urinary tract infection. Choice of antibiotics for lower UTI: NICE identified 3 RCTs comparing trimethoprim to other antibiotics for UTI in children, and one systematic review comparing short and long course of antibiotics for UTI in children that included studies assessing trimethoprim, nitrofurantoin and amoxicillin. The NICE guideline development group recommend trimethoprim, nitrofurantoin, amoxicillin, or cefalexin for empirical treatment of lower UTI in children. Duration of antibiotics for lower UTI: one systematic review found no difference in efficacy between short-courses (2-4 days) and longer courses (7-14 days) of antibiotics in children with lower UTI. Upper UTI: one systematic review combined two studies of co-amoxiclav treatment for 10-14 days compared with IV antibiotic treatment. No difference in efficacy was found.

Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis. Cochrane Database of Systematic Reviews 2007. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003772/frame.html Accessed 23.09.14. RATIONALE: Twenty three studies (3407 children) were eligible for inclusion. No significant differences were found in persistent kidney damage at six to 12 months (824 children: RR 0.80, 95% CI 0.50 to 1.26) or in duration of fever (808 children: MD 2.05, 95% CI -0.84 to 4.94) between oral antibiotic therapy (10 to 14 days of cefixime, ceftibuten or co-amoxiclav) and IV therapy (3 days) followed by oral therapy (10 days).

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).