Low-level pyuria tied to large jump in antibiotic prescribing for suspected pediatric UTI
Retrospective · Pediatrics · 2026-11-06. Number 2 in the UrologyWatch Top 5 for November 7, 2026.
Among 1150 pediatric ambulatory visits with urinalysis, 191 (16.6%) patients received antibiotics, and trace-to-low pyuria was associated with empiric antibiotic initiation (adjusted OR 6.62, 95% CI 3.72-11.79) versus no pyuria. This level of pyuria accounted for an adjusted attributable fraction of 17.0% (95% CI 10.3%-23.2%) for overtreatment in culture-negative children, compared with only 1.8% (95% CI 1.1%-2.4%) attributable fraction for treatment of culture-confirmed UTI.
Why it matters: Suggests that weighing degree of pyuria alongside age, symptoms, and risk factors rather than treating any pyuria as definitive could help reduce unnecessary antibiotic exposure in children evaluated for UTI.
Limitation: This cross-sectional study from four Northern California emergency department and urgent care sites reflects local prescribing patterns that may not generalize elsewhere.
Source: Pediatrics · PubMed 42982088 · DOI 10.1542/peds.2026-077011
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