Updated Italian recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in children AGED between 2 months and 3 years

The aim was to update the recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children, which were first published in 2012 and endorsed by the Italian Society of Paediatric Nephrology. The Italian recommendations were revised on the basis of a review of the literature published from 2012 to October 2018. An ad hoc evaluation of the risk factors, which were published in the previous recommendations, was carried out to identify children with high-grade vesicoureteral reflux or renal scarring. When evidence was not available, the working group held extensive discussions during various meetings and through email exchanges. Four major modifications have been introduced. The method for collecting urine for culture and its interpretation has been re-evaluated. The algorithm that guides clinical decisions to proceed with voiding cystourethrography has been reformulated. The suggested antibiotics have been revised and further restrictions of the use of antibiotic prophylaxis have been recommended. These updated recommendations have now been endorsed by the Italian Society of Paediatric Nephrology and the Italian Society for Paediatric Infectivology. They can also be used to compare other available recommendations, as a worldwide consensus in this area is still lacking.