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Summary: Urinary tract infections in children

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Goilav B

This summary presents key diagnostic risk factors for urinary tract infections (UTIs) in children. The summary also covers diagnostic investigations and treatment algorithms for uncomplicated and complicated UTIs.

Clinical Pathway: Urinary tract infection in under 16s overview

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National Institute for Health and Care Excellence

This clinical pathway contains diagnosis and treatment information for persons under 16 with suspected urinary tract infection.

Summary: Urinary tract infections in children

Visit

Goilav B

This summary presents key diagnostic risk factors for urinary tract infections (UTIs) in children. The summary also covers diagnostic investigations and treatment algorithms for uncomplicated and complicated UTIs.

Clinical Pathway: Urinary tract infection in under 16s overview

Visit

National Institute for Health and Care Excellence

This clinical pathway contains diagnosis and treatment information for persons under 16 with suspected urinary tract infection.

Clinical guidelines English (9) French All (9)

Clinical Practice Guideline: Urinary tract infection

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The Royal Children's Hospital Melbourne

These guidelines provide assessment and management information for children with urinary tract infections.

Clinical Practice Guideline: Urinary tract infection in under 16s: diagnosis and management

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National Institute for Health and Care Excellence

These guidelines contain diagnosis and treatment information for persons under 16 with suspected urinary tract infection.

Clinical Practice Guideline: Urinary tract infection in children and young people

Visit

National Institute for Health and Care Excellence

This quality standard covers diagnosing and managing urinary tract infection in infants, children and young people (under 16). It includes new and recurrent infections of the upper or lower urinary tract. It describes high-quality care in priority areas for improvement.

Clinical Pathways: Urinary Tract Infection (UTI)

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Seattle Children's Hospital

These pathways contain diagnosis and treatment guidance for urinary tract infections in a range of patients (outpatients, inpatients) of different ages (infants, children and adolescents) and presentations (atypical and typical).

Clinical Practice Guideline: Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age

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Subcommittee on Urinary Tract Infection

This article reaffirms the 2011 American Academy of Pediatrics' Urinary Tract Infection Clinical Practice Guidelines and provides an updated review of the supporting evidence.

Clinical Practice Guideline: Urinary tract infections in children: EAU/ESPU guidelines

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Stein R, Dogan HS, Hoebeke P, Kovara R, Nijman RJ, Radmayr C, Tekgl S, Europe...

These European Association of Urology/European Society for Pediatric Urology guidelines provide recommendations for the diagnosis, treatment, and imaging of children presenting with urinary tract infections.

Clinical Practice Guideline: Urinary tract infection in infants and children: Diagnosis and management

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Robinson JL, Finlay JC, Lang ME, Bortolussi R; Canadian Paediatric Society, I...

The Canadian Paediatric Society practice statement focuses on the diagnosis and management of infants and children >2 months of age with an acute urinary tract infection and no known underlying urinary tract pathology or risk factors for a neurogenic bladder.

Clinical Practice Guideline: Technical reportDiagnosis and management of an initial UTI in febrile infants and young children

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Finnell SM, Carroll AE, Downs SM; Subcommittee on Urinary Tract Infection

This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection.

Clinical Practice Guideline: Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months

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Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improv...

These guidelines revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children.

Clinical Practice Guideline: Urinary tract infection

Visit

The Royal Children's Hospital Melbourne

These guidelines provide assessment and management information for children with urinary tract infections.

Clinical Practice Guideline: Urinary tract infection in under 16s: diagnosis and management

Visit

National Institute for Health and Care Excellence

These guidelines contain diagnosis and treatment information for persons under 16 with suspected urinary tract infection.

Clinical Practice Guideline: Urinary tract infection in children and young people

Visit

National Institute for Health and Care Excellence

This quality standard covers diagnosing and managing urinary tract infection in infants, children and young people (under 16). It includes new and recurrent infections of the upper or lower urinary tract. It describes high-quality care in priority areas for improvement.

Clinical Pathways: Urinary Tract Infection (UTI)

Visit

Seattle Children's Hospital

These pathways contain diagnosis and treatment guidance for urinary tract infections in a range of patients (outpatients, inpatients) of different ages (infants, children and adolescents) and presentations (atypical and typical).

Clinical Practice Guideline: Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age

Visit

Subcommittee on Urinary Tract Infection

This article reaffirms the 2011 American Academy of Pediatrics' Urinary Tract Infection Clinical Practice Guidelines and provides an updated review of the supporting evidence.

Clinical Practice Guideline: Urinary tract infections in children: EAU/ESPU guidelines

Visit

Stein R, Dogan HS, Hoebeke P, Kovara R, Nijman RJ, Radmayr C, Tekgl S, Europe...

These European Association of Urology/European Society for Pediatric Urology guidelines provide recommendations for the diagnosis, treatment, and imaging of children presenting with urinary tract infections.

Clinical Practice Guideline: Urinary tract infection in infants and children: Diagnosis and management

Visit

Robinson JL, Finlay JC, Lang ME, Bortolussi R; Canadian Paediatric Society, I...

The Canadian Paediatric Society practice statement focuses on the diagnosis and management of infants and children >2 months of age with an acute urinary tract infection and no known underlying urinary tract pathology or risk factors for a neurogenic bladder.

Clinical Practice Guideline: Technical reportDiagnosis and management of an initial UTI in febrile infants and young children

Visit

Finnell SM, Carroll AE, Downs SM; Subcommittee on Urinary Tract Infection

This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection.

Clinical Practice Guideline: Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months

Visit

Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improv...

These guidelines revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children.

Summaries of systematic reviews English (9) French All (9)

Cochrane Summary: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

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Shaikh N, Borrell JL, Evron J, Leeflang MM

In some children with urinary tract infection (UTI), the infection is localized to the bladder (lower urinary tract). In others, bacteria ascend from the bladder to the kidney (upper urinary tract). Only children with upper urinary tract involvement are at risk for developing permanent kidney damage. If non-invasive biomarkers could accurately differentiate children with lower urinary tract disease from children with upper urinary tract disease, treatment and follow-up could potentially be individualized. Accordingly, we examined the usefulness of three widely available blood tests (procalcitonin, C-reactive protein, erythrocyte sedimentation rate) in differentiating upper from lower urinary tract disease. We found 24 relevant studies of which 17 provided data for our primary outcome. Six studies (434 children) provided data for the procalcitonin test; 13 studies (1638 children) provided data for the C-reactive protein test, and six studies (1737 children) provided data for the erythrocyte sedimentation rate test. We found all three tests to be sensitive (summary sensitivity values ranged from 86% to 95%), but not very specific (summary specificity values ranged from 38% to 71%). None of the tests were accurate enough to allow clinicians to confidently differentiate upper from lower urinary tract disease.

Cochrane Summary: Are oral antibiotics as effective as a combination of injected and oral antibiotics for kidney infections in children?

Visit

Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC

We wanted to find out if oral antibiotics were as effective as combined oral and injected antibiotics to treat children for kidney infection. This review updates our previous investigations published in 2003, 2005 and 2007. This review included evidence from 27 studies that involved 4452 children. The last literature search date was April 2014. This update included evidence from three new studies and from one study that was previously excluded. Review results suggested that children aged over one month with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten or amoxicillin/clavulanic acid) or with short courses (two to four days) of intravenous (IV) therapy followed by oral therapy. If IV therapy with aminoglycosides is needed, single daily dosing is safe and effective.

Cochrane Summary: Antibiotics for covert bacteriuria in children

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Fitzgerald A, Mori R, Lakhanpaul M

Covert bacteriuria occurs when bacteria are found in urine either during routine screening or incidentally during other investigations. Unlike urinary tract infections, children with covert bacteriuria do not appear to have symptoms at the time of diagnosis. There is uncertainty about whether antibiotic treatment can help to clear infection, reduce recurrence, or prevent kidney damage. Any harmful effects of providing treatment also need to be identified and understood. We identified three studies reporting the results on 460 girls. There was insufficient evidence about the harms and benefits of treatments to draw reliable conclusions, but it appears that antibiotic treatment is not likely to benefit children in the long term.

Cochrane Summary: Antibiotics for lower urinary tract infection in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. The most commonly presenting infection of the urinary tract is known as cystitis and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. This review identified 16 studies investigating antibiotics for UTI in children. Results suggest that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments; there was not enough data to draw conclusions about other treatment durations, or effectiveness of particular antibiotics. Although antibiotic treatment is effective for children with UTI, there are insufficient data to recommend any specific regimen.

Cochrane Summary: Long-term antibiotics for preventing recurrent urinary tract infection in children

Visit

Williams G, Craig JC

Bladder and kidney infections (urinary tract infection - UTI) are common in children, especially girls. They cause an uncomfortable illness that can include vomiting, fever and tiredness. In some children kidney damage may occur, as can repeat illnesses. With repeated infections the risk of kidney damage increases. Some doctors prescribe long-term antibiotics to try to prevent infections recurring, but this may cause the child to be unwell in other ways, e.g. vomiting. This review of randomised controlled trials (RCTs) found evidence that long-term antibiotics did reduce the risk of more symptomatic infections but the benefit is small and must be weighed against the likelihood that future infections may be with bacteria that are resistant to the antibiotic given.

DARE Quality-assessed Reviews: Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis

Visit

Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC

This review assessed rapid urine tests for the diagnosis of urinary tract infection in children and concluded that no one test could identify all urinary tract infections without urine culture, but Gram-stain microscopy was the best single test. Dipstick tests should be considered positive if either leucocyte esterase or nitrite was positive. These conclusions are likely to be reliable.

DARE Quality-assessed Reviews: Systematic review of the diagnostic accuracy of C-reactive protein to detect bacterial infection in nonhospitalized infants and children with fever

Visit

Sanders S, Barnett A, Correa-Velez I, Coulthard M, Doust J

The review assessed the accuracy of C-reactiveproteinfor diagnosingbacterial infectionsin febrile children and used robust reviewing and meta-analytic methods. The authors' conclusion that C-reactive protein provided moderate and independent information for ruling-in and ruling-out seriousbacterial infection, but cannot be used alone to exclude bacterial infection, is likely to be reliable.

DARE Quality-assessed Reviews: Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Visit

Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J

This review concluded that for the diagnosis of urinary tract infection (UTI), dipstick negative for both leucocyte esterase and nitrite or negative microscopic analysis for pyuria of a clean voided urine, bag or nappy/pad specimen may be used to rule out UTI, and that combinations of positive tests could similarly be used to rule in UTI. These conclusions are likely to be reliable.

Cochrane Summary: Short courses of antibiotics (2-4 days) are as effective as longer treatment for bladder infections in children

Visit

Michael M, Hodson EM, Craig JC, Martin S, Moyer VA

Bladder and kidney infections (urinary tract infections - UTI) are common in children. Bladder infections cause pain on passing urine and frequency of urination. Some children keep getting repeat bouts. Standard courses of antibiotics (7-10 days) are used to clear the infection. Shorter courses may reduce adverse effects and costs, but there has been concern that they might reduce the chances of clearing the infection and increase the risk of recurrence. A review of studies found that short courses of antibiotics (2-4 days) used for bladder infections are as effective as standard courses at clearing UTI, with no increase in recurrence.

Cochrane Summary: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

Visit

Shaikh N, Borrell JL, Evron J, Leeflang MM

In some children with urinary tract infection (UTI), the infection is localized to the bladder (lower urinary tract). In others, bacteria ascend from the bladder to the kidney (upper urinary tract). Only children with upper urinary tract involvement are at risk for developing permanent kidney damage. If non-invasive biomarkers could accurately differentiate children with lower urinary tract disease from children with upper urinary tract disease, treatment and follow-up could potentially be individualized. Accordingly, we examined the usefulness of three widely available blood tests (procalcitonin, C-reactive protein, erythrocyte sedimentation rate) in differentiating upper from lower urinary tract disease. We found 24 relevant studies of which 17 provided data for our primary outcome. Six studies (434 children) provided data for the procalcitonin test; 13 studies (1638 children) provided data for the C-reactive protein test, and six studies (1737 children) provided data for the erythrocyte sedimentation rate test. We found all three tests to be sensitive (summary sensitivity values ranged from 86% to 95%), but not very specific (summary specificity values ranged from 38% to 71%). None of the tests were accurate enough to allow clinicians to confidently differentiate upper from lower urinary tract disease.

Cochrane Summary: Are oral antibiotics as effective as a combination of injected and oral antibiotics for kidney infections in children?

Visit

Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC

We wanted to find out if oral antibiotics were as effective as combined oral and injected antibiotics to treat children for kidney infection. This review updates our previous investigations published in 2003, 2005 and 2007. This review included evidence from 27 studies that involved 4452 children. The last literature search date was April 2014. This update included evidence from three new studies and from one study that was previously excluded. Review results suggested that children aged over one month with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten or amoxicillin/clavulanic acid) or with short courses (two to four days) of intravenous (IV) therapy followed by oral therapy. If IV therapy with aminoglycosides is needed, single daily dosing is safe and effective.

Cochrane Summary: Antibiotics for covert bacteriuria in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M

Covert bacteriuria occurs when bacteria are found in urine either during routine screening or incidentally during other investigations. Unlike urinary tract infections, children with covert bacteriuria do not appear to have symptoms at the time of diagnosis. There is uncertainty about whether antibiotic treatment can help to clear infection, reduce recurrence, or prevent kidney damage. Any harmful effects of providing treatment also need to be identified and understood. We identified three studies reporting the results on 460 girls. There was insufficient evidence about the harms and benefits of treatments to draw reliable conclusions, but it appears that antibiotic treatment is not likely to benefit children in the long term.

Cochrane Summary: Antibiotics for lower urinary tract infection in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. The most commonly presenting infection of the urinary tract is known as cystitis and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. This review identified 16 studies investigating antibiotics for UTI in children. Results suggest that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments; there was not enough data to draw conclusions about other treatment durations, or effectiveness of particular antibiotics. Although antibiotic treatment is effective for children with UTI, there are insufficient data to recommend any specific regimen.

Cochrane Summary: Long-term antibiotics for preventing recurrent urinary tract infection in children

Visit

Williams G, Craig JC

Bladder and kidney infections (urinary tract infection - UTI) are common in children, especially girls. They cause an uncomfortable illness that can include vomiting, fever and tiredness. In some children kidney damage may occur, as can repeat illnesses. With repeated infections the risk of kidney damage increases. Some doctors prescribe long-term antibiotics to try to prevent infections recurring, but this may cause the child to be unwell in other ways, e.g. vomiting. This review of randomised controlled trials (RCTs) found evidence that long-term antibiotics did reduce the risk of more symptomatic infections but the benefit is small and must be weighed against the likelihood that future infections may be with bacteria that are resistant to the antibiotic given.

DARE Quality-assessed Reviews: Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis

Visit

Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC

This review assessed rapid urine tests for the diagnosis of urinary tract infection in children and concluded that no one test could identify all urinary tract infections without urine culture, but Gram-stain microscopy was the best single test. Dipstick tests should be considered positive if either leucocyte esterase or nitrite was positive. These conclusions are likely to be reliable.

DARE Quality-assessed Reviews: Systematic review of the diagnostic accuracy of C-reactive protein to detect bacterial infection in nonhospitalized infants and children with fever

Visit

Sanders S, Barnett A, Correa-Velez I, Coulthard M, Doust J

The review assessed the accuracy of C-reactiveproteinfor diagnosingbacterial infectionsin febrile children and used robust reviewing and meta-analytic methods. The authors' conclusion that C-reactive protein provided moderate and independent information for ruling-in and ruling-out seriousbacterial infection, but cannot be used alone to exclude bacterial infection, is likely to be reliable.

DARE Quality-assessed Reviews: Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Visit

Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J

This review concluded that for the diagnosis of urinary tract infection (UTI), dipstick negative for both leucocyte esterase and nitrite or negative microscopic analysis for pyuria of a clean voided urine, bag or nappy/pad specimen may be used to rule out UTI, and that combinations of positive tests could similarly be used to rule in UTI. These conclusions are likely to be reliable.

Cochrane Summary: Short courses of antibiotics (2-4 days) are as effective as longer treatment for bladder infections in children

Visit

Michael M, Hodson EM, Craig JC, Martin S, Moyer VA

Bladder and kidney infections (urinary tract infections - UTI) are common in children. Bladder infections cause pain on passing urine and frequency of urination. Some children keep getting repeat bouts. Standard courses of antibiotics (7-10 days) are used to clear the infection. Shorter courses may reduce adverse effects and costs, but there has been concern that they might reduce the chances of clearing the infection and increase the risk of recurrence. A review of studies found that short courses of antibiotics (2-4 days) used for bladder infections are as effective as standard courses at clearing UTI, with no increase in recurrence.

Systematic reviews English (18) French All (18)

Review: A critical review of recent clinical practice guidelines for pediatric urinary tract infection

Visit

Chua M, Ming J, Chang SJ, Santos JD, Mistry N, Silangcruz JM, Bayley M, Koyle MA

Concerns regarding the quality, credibility, and applicability of recently published pediatric urinary tract infection (UTI) clinical practice guidelines have been raised due to the inconsistencies of recommendations between them. This review aimed to determine the quality of the recent clinical practice guidelines on pediatric UTI by using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, and summarize the standard of care in diagnosis and management of pediatric UTI from the top three clinical practice guidelines.

Review: Urinary tract infection in children

Visit

Hudson A, Romao RLP, MacLellan D

This review presents summary recommendations for diagnosing urinary tract infection in children.

Review: The clinical diagnosis and management of urinary tract infections in children and adolescents

Visit

Korbel L, Howell M, Spencer JD

In this manuscript, the authors review the diagnosis and management of acute and recurrent urinary tract infection in the paediatric and adolescent populations.

Systematic Review: Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis

Visit

Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C

Objectives: To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance.

Review: Diagnosis of Urinary Tract Infections in Children

Visit

Doern CD, Richardson SE

This review discusses the management and laboratory diagnoses of urinary tract infections in children. Important factors, such as specimen collection, urinalysis interpretation, culture thresholds, and antimicrobial susceptibility testing are covered.

Cochrane Systematic Review: Probiotics for preventing urinary tract infections in adults and children

Visit

Schwenger EM, Tejani AM, Loewen PS

This systematic review addressed the questions: Compared to placebo or no therapy, did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality, when used to prevent UTI in susceptible patient populations? Compared to other prophylactic interventions, including drug and non-drug measures (e.g. continuous antibiotic prophylaxis, topical oestrogen, cranberry juice), did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality when used to prevent UTIs in susceptible patient populations?

Cochrane Systematic Review: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

Visit

Shaikh N, Borrell JL, Evron J, Leeflang MM

The objectives of this review were to 1) determine whether procalcitonin, C-reactive protein, erythrocyte sedimentation rate can replace the acute DMSA scan in the diagnostic evaluation of children with urinary tract infections; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other.

Cochrane Systematic Review: Antibiotics for acute pyelonephritis in children

Visit

Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC

The objectives of this review were to evaluate the benefits and harms of antibiotics used to treat children with acute pyelonephritis. The aspects of therapy considered were 1) different antibiotics, 2) different dosing regimens of the same antibiotic, 3) different duration of treatment, and 4) different routes of administration.

Review: Pediatric urinary tract infection: does the evidence support aggressively pursuing the diagnosis?

Visit

Newman DH, Shreves AE, Runde DP

The authors review both early and emerging literature to examine the utility and efficacy of early identification and treatment of urinary tract infection in children younger than 24 months.

Cochrane Systematic Review: Antibiotics for treating lower urinary tract infection in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

This review aims to summarise the benefits and harms of antibiotics for treating lower urinary tract infection in children.

Systematic Review: Technical reportDiagnosis and management of an initial UTI in febrile infants and young children

Visit

Finnell SM, Carroll AE, Downs SM; Subcommittee on Urinary Tract Infection

This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection.

Systematic Review: Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months

Visit

Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improv...

The objectives of this review are to revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children.

Cochrane Systematic Review: Long-term antibiotics for preventing recurrent urinary tract infection in children

Visit

Williams G, Craig JC

The objectives of this review are to determine the efficacy and harms of long-term antibiotics to prevent recurrent urinary tract infections in children.

Systematic Review: Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis

Visit

Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC

Rapid urine tests, such as microscopy, for bacteria and white cells, and dipsticks, for leucocyte esterase and nitrites, are often used in children that are unwell to guide early diagnosis and treatment of urinary tract infection. This review aimed to establish whether these tests were sufficiently sensitive to avoid urine culture in children with negative results and to compare the accuracy of dipsticks with microscopy.

Review: Does this child have a urinary tract infection?

Visit

Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, W...

This article reviews the diagnostic accuracy of symptoms and signs for the diagnosis of urinary tract infection in infants and children.

Systematic Review: Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

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Whiting P, Westwood M, Bojke L, Palmer S, Richardson G, Cooper J, Watt I, Gla...

The objectives of this systematic review are to determine the diagnostic accuracy of tests for detecting urinary tract infection (UTI) in children under 5 years of age and to evaluate the effectiveness of tests used to investigate further children with confirmed UTI. Also, to evaluate the effectiveness of following up children with UTI and the cost-effectiveness of diagnostic and imaging tests for the diagnosis and follow-up of UTI in children under 5. An additional objective was to develop a preliminary diagnostic algorithm for healthcare professionals.

Systematic Review: Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years

Visit

Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J

This systematic review was conducted to determine the diagnostic accuracy of rapid tests for detecting urinary tract infection in children under five years of age.

Cochrane Systematic Review: Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children

Visit

Michael M, Hodson EM, Craig JC, Martin S, Moyer VA

The objective of this review was to assess the benefits and harms of short-course (2-4 days) compared to standard duration (7-14 days) oral antibiotic treatment for acute urinary tract infection in children.

Review: A critical review of recent clinical practice guidelines for pediatric urinary tract infection

Visit

Chua M, Ming J, Chang SJ, Santos JD, Mistry N, Silangcruz JM, Bayley M, Koyle MA

Concerns regarding the quality, credibility, and applicability of recently published pediatric urinary tract infection (UTI) clinical practice guidelines have been raised due to the inconsistencies of recommendations between them. This review aimed to determine the quality of the recent clinical practice guidelines on pediatric UTI by using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, and summarize the standard of care in diagnosis and management of pediatric UTI from the top three clinical practice guidelines.

Review: Urinary tract infection in children

Visit

Hudson A, Romao RLP, MacLellan D

This review presents summary recommendations for diagnosing urinary tract infection in children.

Review: The clinical diagnosis and management of urinary tract infections in children and adolescents

Visit

Korbel L, Howell M, Spencer JD

In this manuscript, the authors review the diagnosis and management of acute and recurrent urinary tract infection in the paediatric and adolescent populations.

Systematic Review: Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis

Visit

Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C

Objectives: To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance.

Review: Diagnosis of Urinary Tract Infections in Children

Visit

Doern CD, Richardson SE

This review discusses the management and laboratory diagnoses of urinary tract infections in children. Important factors, such as specimen collection, urinalysis interpretation, culture thresholds, and antimicrobial susceptibility testing are covered.

Cochrane Systematic Review: Probiotics for preventing urinary tract infections in adults and children

Visit

Schwenger EM, Tejani AM, Loewen PS

This systematic review addressed the questions: Compared to placebo or no therapy, did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality, when used to prevent UTI in susceptible patient populations? Compared to other prophylactic interventions, including drug and non-drug measures (e.g. continuous antibiotic prophylaxis, topical oestrogen, cranberry juice), did probiotics (any formulation) provide a therapeutic advantage in terms of morbidity and mortality when used to prevent UTIs in susceptible patient populations?

Cochrane Systematic Review: Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

Visit

Shaikh N, Borrell JL, Evron J, Leeflang MM

The objectives of this review were to 1) determine whether procalcitonin, C-reactive protein, erythrocyte sedimentation rate can replace the acute DMSA scan in the diagnostic evaluation of children with urinary tract infections; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other.

Cochrane Systematic Review: Antibiotics for acute pyelonephritis in children

Visit

Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC

The objectives of this review were to evaluate the benefits and harms of antibiotics used to treat children with acute pyelonephritis. The aspects of therapy considered were 1) different antibiotics, 2) different dosing regimens of the same antibiotic, 3) different duration of treatment, and 4) different routes of administration.

Review: Pediatric urinary tract infection: does the evidence support aggressively pursuing the diagnosis?

Visit

Newman DH, Shreves AE, Runde DP

The authors review both early and emerging literature to examine the utility and efficacy of early identification and treatment of urinary tract infection in children younger than 24 months.

Cochrane Systematic Review: Antibiotics for treating lower urinary tract infection in children

Visit

Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

This review aims to summarise the benefits and harms of antibiotics for treating lower urinary tract infection in children.

Systematic Review: Technical reportDiagnosis and management of an initial UTI in febrile infants and young children

Visit

Finnell SM, Carroll AE, Downs SM; Subcommittee on Urinary Tract Infection

This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection.

Systematic Review: Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months

Visit

Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improv...

The objectives of this review are to revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections in febrile infants and young children.

Cochrane Systematic Review: Long-term antibiotics for preventing recurrent urinary tract infection in children

Visit

Williams G, Craig JC

The objectives of this review are to determine the efficacy and harms of long-term antibiotics to prevent recurrent urinary tract infections in children.

Systematic Review: Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis

Visit

Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC

Rapid urine tests, such as microscopy, for bacteria and white cells, and dipsticks, for leucocyte esterase and nitrites, are often used in children that are unwell to guide early diagnosis and treatment of urinary tract infection. This review aimed to establish whether these tests were sufficiently sensitive to avoid urine culture in children with negative results and to compare the accuracy of dipsticks with microscopy.

Review: Does this child have a urinary tract infection?

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Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, W...

This article reviews the diagnostic accuracy of symptoms and signs for the diagnosis of urinary tract infection in infants and children.

Systematic Review: Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

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Whiting P, Westwood M, Bojke L, Palmer S, Richardson G, Cooper J, Watt I, Gla...

The objectives of this systematic review are to determine the diagnostic accuracy of tests for detecting urinary tract infection (UTI) in children under 5 years of age and to evaluate the effectiveness of tests used to investigate further children with confirmed UTI. Also, to evaluate the effectiveness of following up children with UTI and the cost-effectiveness of diagnostic and imaging tests for the diagnosis and follow-up of UTI in children under 5. An additional objective was to develop a preliminary diagnostic algorithm for healthcare professionals.

Systematic Review: Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years

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Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J

This systematic review was conducted to determine the diagnostic accuracy of rapid tests for detecting urinary tract infection in children under five years of age.

Cochrane Systematic Review: Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children

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Michael M, Hodson EM, Craig JC, Martin S, Moyer VA

The objective of this review was to assess the benefits and harms of short-course (2-4 days) compared to standard duration (7-14 days) oral antibiotic treatment for acute urinary tract infection in children.

Key studies English (16) French All (16)

Key Study: Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children

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Shaikh N, Hoberman A, Hum SW, Alberty A, Muniz G, Kurs-Lasky M, Landsittel D,...

The objective of this study is to develop and test a calculator (UTICalc) that can first estimate the probability of urinary tract infection based on clinical variables and then update that probability based on laboratory results.

Key Study: Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger

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Tzimenatos L, Mahajan P, Dayan PS, Vitale M, Linakis JG, Blumberg S, Borgiall...

This study evaluated the test characteristics of the urinalysis for diagnosing urinary tract infections, with and without associated bacteremia, in young febrile infants.

Key Study: Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring

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Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanidis CJ

This study evaluated the controversial relationship between the duration of fever before treatment initiation for a febrile urinary tract infection, with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings.

Key Study: Testing for Urinary Tract Infection in the Influenza/Respiratory Syncytial Virus-Positive Febrile Infant Aged 2 to 12 Months

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Schlechter Salinas AK, Hains DS, Jones T, Harrell C, Meredith M

This study assessed the prevalence of urinary tract infection (UTI) in febrile RSV/influenza positive infants aged 2 to 12 months presenting to the emergency department. We also examined whether the 2011 American Academy of Pediatrics UTI clinical practice guidelines could be used to identify patients at lower risk of UTI.

Key Study: The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care

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Hay AD, Birnie K, Busby J, Delaney B, Downing H, Dudley J, Durbaba S, Fletche...

The objective of this study was to develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.

Key Study: Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Stud

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Hay AD, Sterne JA, Hood K, Little P, Delaney B, Hollingworth W, Wootton M, Ho...

Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. The aim of this study was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment.

Key Study: Predictors of Antimicrobial Resistance among Pathogens Causing Urinary Tract Infection in Children

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Shaikh N, Hoberman A, Keren R, Ivanova A, Gotman N, Chesney RW, Carpenter MA,...

The objective of this study was to determine which children with urinary tract infection are likely to have pathogens resistant to narrow-spectrum antimicrobials.

Key Study: Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring

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Shaikh N, Mattoo TK, Keren R, Ivanova A, Cui G, Moxey-Mims M, Majd M, Ziessma...

The objective of this study was to determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections is associated with the occurrence and severity of renal scarring.

Key Study: Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group

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Alberici I, Bayazit AK, Drozdz D, Emre S, Fischbach M, Harambat J, Jankauskie...

The objective of this study was to determine the pathogens in positive urine cultures from hospitalized and non-hospitalized infants under 24 months of age.

Key Study: Accuracy of a new clean-catch technique for diagnosis of urinary tract infection in infants younger than 90 days of age

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Herreros ML, Tagarro A, Garca-Pose A, Snchez A, Caete A, Gili P

The objective of this study was to evaluate the accuracy of diagnosing urinary tract infections using a new, recently described, standardized clean-catch collection technique.

Key Study: Diagnostic accuracy of the urinalysis for urinary tract infection in infants <3 months of age

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Schroeder AR, Chang PW, Shen MW, Biondi EA, Greenhow TL

The purpose of this study was to determine the accuracy (sensitivity and specificity) of urinalysis for diagnosing urinary tract infection in infants <3 months of age.

Key Study: Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits

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Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JN

The objective of this study was to test whether active management of urinary tract infections in young children by general practitioners can reduce kidney scarring rates.

Key Study: Outpatient management of young febrile infants with urinary tract infections

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Schnadower D, Kuppermann N, Macias CG, Freedman SB, Agrawal D, Mao J, Dayan P...

This study aimed to determine the variation in patient disposition for young febrile infants who present to emergency departments with urinary tract infections and clinical factors independently associated with outpatient management.

Key Study: Reliability of the urinalysis for predicting urinary tract infections in young febrile children

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Bachur R, Harper MB

The objectives of this study were to determine how the sensitivity of the standard urinalysis as a screening test for urinary tract infection varies with age, and to determine the clinical situation that necessitates the collection of a urine culture regardless of the urinalysis result.

Key Study: Screening for urinary tract infection in infants in the emergency department: which test is best?

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Shaw KN, McGowan KL, Gorelick MH, Schwartz JS

The objective of this study wa to compare rapid tests and screening strategies for detecting urinary tract infection in infants.

Key Study: Is urine culture necessary to rule out urinary tract infection in young febrile children?

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Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M

The objective of this study was to determine whether the absence of pyuria on the enhanced urinalysis can be used to eliminate the diagnosis of urinary tract infection, avoiding the need for urine culture and sparing large health care expenditures.

Key Study: Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children

Visit

Shaikh N, Hoberman A, Hum SW, Alberty A, Muniz G, Kurs-Lasky M, Landsittel D,...

The objective of this study is to develop and test a calculator (UTICalc) that can first estimate the probability of urinary tract infection based on clinical variables and then update that probability based on laboratory results.

Key Study: Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger

Visit

Tzimenatos L, Mahajan P, Dayan PS, Vitale M, Linakis JG, Blumberg S, Borgiall...

This study evaluated the test characteristics of the urinalysis for diagnosing urinary tract infections, with and without associated bacteremia, in young febrile infants.

Key Study: Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring

Visit

Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanidis CJ

This study evaluated the controversial relationship between the duration of fever before treatment initiation for a febrile urinary tract infection, with renal scarring based on dimercaptosuccinic acid scintigraphy (DMSA) findings.

Key Study: Testing for Urinary Tract Infection in the Influenza/Respiratory Syncytial Virus-Positive Febrile Infant Aged 2 to 12 Months

Visit

Schlechter Salinas AK, Hains DS, Jones T, Harrell C, Meredith M

This study assessed the prevalence of urinary tract infection (UTI) in febrile RSV/influenza positive infants aged 2 to 12 months presenting to the emergency department. We also examined whether the 2011 American Academy of Pediatrics UTI clinical practice guidelines could be used to identify patients at lower risk of UTI.

Key Study: The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care

Visit

Hay AD, Birnie K, Busby J, Delaney B, Downing H, Dudley J, Durbaba S, Fletche...

The objective of this study was to develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness.

Key Study: Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Stud

Visit

Hay AD, Sterne JA, Hood K, Little P, Delaney B, Hollingworth W, Wootton M, Ho...

Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. The aim of this study was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment.

Key Study: Predictors of Antimicrobial Resistance among Pathogens Causing Urinary Tract Infection in Children

Visit

Shaikh N, Hoberman A, Keren R, Ivanova A, Gotman N, Chesney RW, Carpenter MA,...

The objective of this study was to determine which children with urinary tract infection are likely to have pathogens resistant to narrow-spectrum antimicrobials.

Key Study: Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring

Visit

Shaikh N, Mattoo TK, Keren R, Ivanova A, Cui G, Moxey-Mims M, Majd M, Ziessma...

The objective of this study was to determine whether delay in the initiation of antimicrobial therapy for febrile urinary tract infections is associated with the occurrence and severity of renal scarring.

Key Study: Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group

Visit

Alberici I, Bayazit AK, Drozdz D, Emre S, Fischbach M, Harambat J, Jankauskie...

The objective of this study was to determine the pathogens in positive urine cultures from hospitalized and non-hospitalized infants under 24 months of age.

Key Study: Accuracy of a new clean-catch technique for diagnosis of urinary tract infection in infants younger than 90 days of age

Visit

Herreros ML, Tagarro A, Garca-Pose A, Snchez A, Caete A, Gili P

The objective of this study was to evaluate the accuracy of diagnosing urinary tract infections using a new, recently described, standardized clean-catch collection technique.

Key Study: Diagnostic accuracy of the urinalysis for urinary tract infection in infants <3 months of age

Visit

Schroeder AR, Chang PW, Shen MW, Biondi EA, Greenhow TL

The purpose of this study was to determine the accuracy (sensitivity and specificity) of urinalysis for diagnosing urinary tract infection in infants <3 months of age.

Key Study: Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits

Visit

Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JN

The objective of this study was to test whether active management of urinary tract infections in young children by general practitioners can reduce kidney scarring rates.

Key Study: Outpatient management of young febrile infants with urinary tract infections

Visit

Schnadower D, Kuppermann N, Macias CG, Freedman SB, Agrawal D, Mao J, Dayan P...

This study aimed to determine the variation in patient disposition for young febrile infants who present to emergency departments with urinary tract infections and clinical factors independently associated with outpatient management.

Key Study: Reliability of the urinalysis for predicting urinary tract infections in young febrile children

Visit

Bachur R, Harper MB

The objectives of this study were to determine how the sensitivity of the standard urinalysis as a screening test for urinary tract infection varies with age, and to determine the clinical situation that necessitates the collection of a urine culture regardless of the urinalysis result.

Key Study: Screening for urinary tract infection in infants in the emergency department: which test is best?

Visit

Shaw KN, McGowan KL, Gorelick MH, Schwartz JS

The objective of this study wa to compare rapid tests and screening strategies for detecting urinary tract infection in infants.

Key Study: Is urine culture necessary to rule out urinary tract infection in young febrile children?

Visit

Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M

The objective of this study was to determine whether the absence of pyuria on the enhanced urinalysis can be used to eliminate the diagnosis of urinary tract infection, avoiding the need for urine culture and sparing large health care expenditures.