Urinary tract infection

Urinary tract infection

Clinical features

 Signs and symptoms of urinary tract infection (UTI) can be non-specific in young children

Infants and pre-verbal children may present with non-specific symptoms such as

Fever

Vomiting

Poor feeding

Lethargy

Irritability

Older children may present with more typical symptoms such as

Dysuria

Urinary frequency

Lower abdominal and loin pain

Lower abdominal/ loin tenderness

Investigation

Collecting urine to exclude UTI is not required if there is another clear focus of fever and the child is not unwell

A urinary dipstick is a useful screening test but a positive urine culture with pyuria confirms the diagnosis

Management

Oral antibiotics are appropriate for most children with UTI.

Children who are seriously unwell and most infants under 3 months usually require IV antibiotics

Cefalexin 33 mg/kg (max 500 mg) oral bd

For pyelonephritis:

Admit to hospital

IV antibiotics: gentamicin + benzylpenicillin

cefalexin 45 mg/kg (max 1.5 g) oral TDS

Boys <3 months of age should have a renal ultrasound

Ultrasound should be arranged for children who have recurrent UTIs as in the above case

Other children do not require an ultrasound for a first UTI