Clinical recommendation	Evidence rating	References
UTI should be suspected in patients with leukocyte esterase and nitrite present on dipstick testing, or with pyuria of at least 10 white blood cells per high-power field and bacteriuria on microscopy.	C	13, 16
In young children, urine samples collected with a bag are unreliable in the evaluation of UTI.	C	17
The recommended initial antibiotic for most children with UTI is trimethoprim/sulfamethoxazole (Bactrim, Septra). Alternative antibiotics include amoxicillin/clavulanate (Augmentin) or cephalosporins, such as cefixime (Suprax), cefpodoxime, cefprozil (Cefzil), or cephalexin (Keflex).	C	10
A two- to four-day course of oral antibiotics is as effective as a seven- to 14-day course in children with a lower UTI. A single-dose or single-day course is not recommended.	A	19–21
Children with acute pyelonephritis can be treated effectively with oral antibiotics (e.g., amoxicillin/clavulanate, cefixime, ceftibuten [Cedax]) for 10 to 14 days or with short courses (two to four days) of intravenous therapy followed by oral therapy.	A	24
Prophylactic antibiotics do not reduce the risk of recurrent UTIs, even in children with mild to moderate vesicoureteral reflux.	B	25–27
Routine circumcision in boys does not reduce the risk of UTI enough to justify the risk of surgical complications.	B	32