Antibiotic Stewardship in Pediatric Urinary Tract Infections: Current Evidence and Practical Strategies
Abstract
Background/Objectives: Urinary tract infections (UTIs) are among the most common bacterial infections in children and represent a leading indication for antibiotic prescribing across inpatient, emergency department, and outpatient settings. Despite the availability of multiple international guidelines, prescribing practices for pediatric UTI frequently deviate from evidence-based recommendations in antibiotic selection, route of administration, and duration of therapy. These suboptimal practices contribute to the emergence of resistant uropathogens, including extended-spectrum β-lactamase-producing organisms, and highlight the need for a comprehensive stewardship approach specific to this population. Methods: A literature search was performed using PubMed and MEDLINE from January 2000 to May 2026 using the following search terms: urinary tract infection, children, pediatrics, antibiotic stewardship, antimicrobial resistance, diagnosis, treatment, duration, prophylaxis, and intravenous-to-oral transition. Thirteen active international guidelines published between 2011 and 2025 were identified and evaluated with specific emphasis on the integration of antibiotic stewardship principles. Clinical trials, systematic reviews, meta-analyses, and quality improvement studies addressing stewardship-relevant outcomes in pediatric UTI were included. Case reports were excluded. Results: Comparative analysis of 13 international UTI treatment guidelines demonstrated substantial variation…
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