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Urinary tract infection - children - Management
When should I treat UTI in a child between 3 months and 3 years of age with an antibiotic?
For infants and children older than 3 months and younger than 3 years who have a urinary tract infection (UTI) and do not need urgent referral/admission:
- Obtain a urine specimen for culture and sensitivities prior to starting antibiotics.
- Treat immediately with an antibiotic:
- For upper UTI (acute pyelonephritis) if:
- Fever of greater than 38°C and bacteriuria, or
- Fever of less than 38°C and loin pain/tenderness and bacteriuria.
- For lower UTI (cystitis) if:
- Specific symptoms of cystitis (e.g. frequency dysuria), or
- Non-specific symptoms of UTI and bacteriuria present on urgent microscopy (or, if urgent microscopy is not available, nitrite positive with urine dipstick test).
- Delay the decision about treating with an antibiotic until the results of urine culture and routine microscopy are available:
- For infants and children who have no specific symptoms for UTI, and are at:
- Intermediate risk for severe illness, and urgent urine microscopy shows no bacteriuria or leukocytes (or, if urgent microscopy is not available, the urine dipstick tests for nitrite and leukocyte esterase are negative).
- Low risk for serious illness (urgent microscopy is not needed).
Clarification / Additional information
- Most infants and 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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