Escherichia coli is the most common organism in all patient groups, but Klebsiella, Pseudomonas, Proteus, and other organisms are more common in patients with certain risk factors for complicated urinary tract infections. Antibiotic prophylaxis to prevent recurrent UTI may be considered in infants and children with or without vesicoureteral reflux (VUR) after a first UTI.
Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. A large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community-acquired urinary tract infections. Treatment of complicated UTIs should begin with broad-spectrum antibiotic coverage, with adjustment of antimicrobial coverage guided by culture results. Prophylactic antimicrobial therapy to prevent recurrent UTIs is not recommended for patients with complicated UTIs.