An analysis of more than 10 years of scientific research has led the American Academy of Pediatrics (AAP) to change its recommendations for the diagnosis and treatment of initial urinary tract infections (UTIs) in infants and children, it has been reported. This change will affect thousands of children each year. The results argue against a painful radiologic examination and prescription of antibiotics for prophylactic treatment of all young children diagnosed with an initial urinary tract infection that can last for several years, a diagnosis and management approach indicated in the AAP’s existing guidelines (developed in 1999). This new study was conducted at the request of the AAP. As a result of these findings, the AAP has updated its practice guidelines for the diagnosis and management of children aged 2 to 24 years with initial urinary tract infections. The report and the new AAP guidelines will be published in the September issue of Pediatrics. Clinically, the diagnosis and management of urinary tract infections can be challenging because patients are unable to express their symptoms. Recurrent urinary tract infections can lead to kidney scarring and lifelong decline in kidney function. In the 1999 guidelines, excretory cystourethrography photographs (VCUG) are recommended for young children with initial UTI. This is done to identify if the child has urine reflux to the kidneys. When the presence was determined, most of these children were started on prophylactic antibiotics to prevent recurrent UTIs. However, when the researchers reviewed studies completed over the past 10 years after the old guidelines were established in 1999, they found no benefit to long-term prophylactic antibiotics. Since antibiotics didn’t work, they decided there was no reason to subject all of these children to painful and radioactive VCUG. Lead author Maria Finnell, M.D., of Indiana University School of Medicine, says pediatricians need to consider UTI and test for it if there is no obvious source of fever. But now after we’ve treated the initial urinary tract infection we need to change our approach. As physicians, we have fooled ourselves by putting young patients on long-term antibiotics and thinking we can prevent them from getting another UTI.