Editing AUA: Vesicoureteral Reflux (2017) (section)

== Interventions for the Child with Breakthrough UTI ==

* '''<span style="color:#ff0000">If symptomatic breakthrough UTI occurs in a child with VUR receiving CAP, a change in therapy is recommended'''
** The occurrence of a febrile breakthrough UTI indicates a failure of therapy and raises the concern for renal injury. 
**'''Symptoms of breakthrough UTI include fever, dysuria, frequency, failure to thrive, or poor feeding'''
*** The clinical manifestations of breakthrough UTI may not be classic, particularly in the younger child in whom systemic symptoms may predominate.
**'''The specific alternative therapy should be determined based upon the individual risks to the patient, which include clinical factors such as:'''
*** '''Reflux grade'''
*** '''Degree of scarring'''
*** '''BBD'''
* '''<span style="color:#ff0000">Recommended: intervention (open surgical ureteral reimplantation or endoscopic injection of bulking agents) with curative intent in patients receiving CAP with a febrile breakthrough UTI'''
* '''<span style="color:#ff0000">Option: In patients receiving CAP with a single febrile breakthrough UTI and no evidence of renal cortical abnormalities (pre-existing or new), changing to an alternative antibiotic agent is an option prior to intervention with curative intent'''
* '''<span style="color:#ff0000">In patients not receiving CAP who develop a:'''
** '''<span style="color:#ff0000">Febrile UTI, initiation of CAP is recommended'''
** '''<span style="color:#ff0000">Non-febrile UTI, initiation of CAP is an option in recognition of the fact that not all cases of pyelonephritis are associated with fever'''