Table 4.

Summary of recommendations

	Criteria positive of urine culture	Antibiotic prophylaxis	Imaging
			Age	RBUS	VCUG	DMSA
AAP	BC/SPA: ≥5×104 CFU/mL	/	2–24 months	All of febrile infants	Abnormal RBUS or other specific circumstances	/
EAU/ESPU	SPA: any; BC: ≥103–5×104 CFU/mL; CVU: ≥104 CFU/mL with symptoms or ≥105 CFU/mL without symptoms	VUR III-V	/	All of febrile children	In febrile UTI children: <1 year, >1 year girl, >1 year boy with recurrent febrile UTI and toilet-trained children who were suspected of VUR
SINePe	SPA: >104 CFU/mL BC: >104 CFU/mL CVU: >5×104 CFU/mL Urinary bag: >105 CFU/mL	VUR Ⅳ–Ⅴ, recurrent febrile UTI; dose: one‐quarter to one‐third of the treatment dose; course: 12–24 months in girls and 6–12 months in boys.	2–36 months	All of febrile children*	Abnormal RBUS or other high-risk factors†	VUR IV–V
KHA-CARI	SPA: any; BC: >105 CFU/mL; CVU: >105 CFU/mL	A severe index UTI, recurrent UTI, VUR III–V; course: 6–24 months low dose	/	First UTI, not had antenatal ultrasound, had some special cases‡	Abnormal RBUS; recurrent pyelonephritis	Renal functional decline
CPS	CVU: ≥5×105 CFU/mL BC: ≥5×104 CFU/mL SPA: any	VUR Ⅳ-Ⅴ	<2 years	All of febrile infants	Abnormal RBUS; recurrent UTI in children <2 years	Only when the diagnosis of UTI is in doubt
			>2 years	/
ISPN§	SPA: any; BC: >5×104 CFU/mL CVU: >105 CFU/mL	All grades of VUR, recurrent UTI; Low dose; Course: VUR Ⅰ-Ⅱ until 1y old, VUR Ⅲ-Ⅴ up to 5y;	<1 years	All UTI children	First UTI in children	First UTI in children
			1–5 years		Abnormal RBUS or DMSA	First UTI in children
			>5 years		Abnormal RBUS	Abnormal RBUS
NICE	/	/	<6 months	All children¶	Atypical/recurrent UTI	Atypical/recurrent UTI
			6 months–3 years	Atypical/recurrent UTI	Not recommend	Atypical/recurrent UTI
			>3 years	Atypical/recurrent UTI	Not recommend	Recurrent UTI
Pyelonephritis guideline**	CVU: >104 CFU/mL in boys and >105 CFU/mL in girls; BC: >104 CFU/mL	Not recommend	All	Boys	Abnormal DMSA	Boys
			＜3 years	Girls		Girls
			3–7 years	Girls with fever >38.5℃		Girls with fever >38.5℃
			＞7 years	Girls do not take any imaging examination
CMA-CSP††	SPA: any G-bacteria, G+bacteria >103 CFU/mL; BC: >105 CFU/mL; CVU: >104 CFU/mL in boys, and three times >105 CFU/mL in girls	Dilated VUR, recurrent UTI; dose: one‐third of treatment dose	≤2 years	First febrile UTI	Abnormal RBUS or DMSA; atypical UTI; recurrent UTI	First febrile UTI
			＞2 years		When RBUS is abnormal, performed as a programme of ≤2 years

*Not recommend RBUS during the febrile UTI, unless it is complicated, atypical or severe (presence of any of the following: septic state, fever persisting after 3 days of appropriate antibiotic treatment, elevated plasma creatinine, oliguria).

†First-degree relative with VUR, septicaemia, chronic kidney disease, age <6 months in a male infant, likely non-compliance of the family, abnormal bladder emptying, no clinical response to correct antibiotic treatment within 72 hours, bacteria other than Escherichia coli.

‡Special cases: bacteraemia,<3 months of age, atypical organisms (eg, Staphylococcus aureus or Pseudomonas), no clinical response to correct antibiotic treatment within 48 hours, renal impairment or significant electrolyte derangement, abdominal mass, poor urinary stream.

§Imaging evaluation of the first UTI.

¶For infants younger than 6 months with a first-time UTI that responds to treatment, ultrasound should be carried out within 6 weeks of the UTI.

**Imaging evaluation of the first pyelonephritis.

††Imaging evaluation of the first febrile UTI.

BC, bladder catheterisation; CVU, clean voided urine; RBUS, renal and bladder ultrasonography; SPA, suprapubic aspiration; UTI, urinary tract infection.