AAP guidelines: Routine VCUG not recommended for young children

New guidelines from the American Academy of Pediatrics do not recommend routine use of voiding cystourethrography (VCUG) after the first urinary tract infection in febrile infants and children aged 2 to 24 months.

Instead, the clinical practice guideline, which was published online in Pediatrics (2011; 128:e749-70), says that VCUG is indicated "if renal and bladder ultrasonography reveals hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy and in other atypical or complex clinical circumstances." Recurrence of a febrile UTI also would call for VCUG.

To diagnose UTI, clinicians should document the presence of both pyuria and at least 50,000 colonies per mL of a single uropathogenic organism in a urine specimen. The guidelines also urge clinical follow-up after 7 to 14 days of antimicrobial treatment to aid in the diagnosis and treatment of any recurrent infections.

The guidelines also state that data from recent clinical studies do not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux or with grade I to IV VUR.