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Urinary tract infection - children - Management
What follow up and aftercare should I provide for a child over 3 years of age treated for urinary tract infection?

Routinely review with the culture result (e.g. at around 48 hours) to ensure that the child is responding to treatment, and to reassess the choice of antibiotic. This can be done by telephone.

  • What if the child is responding but the culture isolated an organism that is resistant to the chosen antibiotic?
    • Many experts, but not all, would recommend switching to a antibiotic to which the organism is sensitive.
    • If the decision is to continue with the original antibiotic, do a 'test of cure' urine culture after the the course of antibiotic has been completed.
  • What if the child is still unwell after 24–48 hours on antibiotic treatment?
    • Advise the parents/carers to bring him or her in for assessment.
    • If an alternative diagnosis is made, manage accordingly.
    • If an alternative diagnosis is not made, and:
      • Urine culture has isolated an organism resistant to the antibiotic being taken, switch to antibiotic to which the organism is sensitive.
      • Urine culture was not made or does not suggest a more appropriate antibiotic, send a urine sample for culture to identify the presence of bacteria and determine antibiotic sensitivity.
  • What if the child has responded well and is no longer symptomatic?
    • Do not send urine for culture as a 'test of cure'.
    • Do not start prophylactic antibiotics; these are rarely necessary. If prophylactic antibiotics are thought to be indicated, refer or consult a paediatric specialist.

Refer urgently to a paediatric specialist if the child has:

  • Poor response to appropriate treatment.
  • A history or clinical features suggesting urinary tract obstruction, such as:
    • High blood pressure.
    • Poor growth.
    • Poor urine flow.
    • Recurrent fever of uncertain origin.
    • Antenatally-diagnosed renal abnormality.
    • Family history of vesicoureteral reflux or renal disease.
    • Enlarged bladder.
    • Abdominal mass.
    • Evidence of spinal lesion.

Refer non-urgently to a paediatric specialist if the child has:

  • History of urinary tract infection (probable or confirmed).
Clarification / Additional information
  • Children who should undergo imaging tests are included in those who should be referred for specialist assessment.
Basis for recommendation

These recommendations are based on the National Institute for Health and Clinical Excellence guideline Urinary tract infection in children: diagnosis, treatment and long-term management [National Collaborating Centre for Women's and Children's Health, 2007].

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