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Urinary tract infection - children - Management
When should I treat UTI in a child over 3 years of age with an antibiotic?
For children over 3 years of age who have a suspected urinary tract infection (UTI) and do not need urgent referral/admission:
- Treat immediately with an antibiotic:
- For upper UTI (acute pyelonephritis) if:
- Fever of greater than 38°C and bacteriuria (or nitrite positive on urine dipstick test), or
- Fever of less than 38°C and loin pain/tenderness and bacteriuria (or nitrite positive on urine dipstick test).
- For lower UTI (cystitis) if:
- Specific symptoms of cystitis (e.g. frequency and dysuria), or
- Non-specific symptoms of UTI and nitrite positive with urine dipstick test (or bacteriuria present on urgent microscopy).
- Before starting antibiotics send a urine specimen for culture and sensitivities unless:
- The child has typical symptoms of uncomplicated cystitis, or
- The child has no specific symptoms of UTI, and is at low risk for serious illness, and the urine dipstick test is negative for both nitrite and leukocyte esterase.
- Delay the decision about antibiotic treatment for lower UTI (cystitis) until the results of urine culture and microscopy are available if the child has no specific symptoms of UTI and if the immediate urine test is equivocal (i.e. dipstick negative for nitrites but positive for leukocyte esterase, or microscopy showed no bacteriuria but found pyuria).
Clarification / Additional information
- Most children with upper urinary tract infection (acute pyelonephritis) will need to be admitted for treatment in secondary care.
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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