Pharmacotherapy of lower urinary tract infections and pyelonephritis in children.

This review focuses on the treatment of urinary tract infections (UTI) in children. Acute pyelonephritis (an infection involving the renal parenchyma), acute cystitis (infection limited to the lower urinary tract) and asymptomatic bacteriuria (absence of clinical symptoms) have to be clearly distinguished. Whereas antibiotics are needed in pyelonephritis and cystitis, they should be used only exceptionally in cases of asymptomatic bacteriuria, as they may be potentially harmful and select more virulent bacteria. In case of pyelonephritis, there should be no delay in beginning the treatment in order to decrease the risk of long term complication in particular renal scars. Predisposing conditions for UTI should be evaluated carefully. New concepts concerning analysis of virulence profile or specific host immune response might bring more comprehension to UTI, but yet these concepts do not influence clinical practice. Any recommendation about (initial) antibiotic treatment should be regularly updated and adapted to local resistance profiles and to economical factors in different health systems.