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Urinary tract infection - children - Management
Overview of management

  • Maintain a high index of suspicion for urinary tract infection (UTI).
  • Assess the risk of severe illness.
  • Refer or admit urgently when:
    • The infant is less than 3 months of age, or
    • The risk of severe illness is high for other reasons.
  • Collect a urine sample using the most appropriate method for the child.
  • Make a preliminary diagnosis by testing the urine:
    • Urgent urine microscopy (if available) for infants and children less than 3 years of age.
    • Dipstick test for children from the age of 3 years onward (or urgent microscopy if available).
  • Culture the urine for all children suspected of UTI, except children over 3 years of age with low risk of serious illness who also:
    • Have typical uncomplicated first lower UTI (cystitis), or
    • Have had UTI excluded by urine dipstick tests (or urgent microscopy).
  • Determine the level of infection (upper or lower UTI).
  • Assess the risk of serious underlying abnormalities.
  • Treat:
    • Upper UTI (acute pyelonephritis) with an oral antibiotic for 7–10 days (most infants and children will require referral to a paediatric specialist).
    • Lower UTI (cystitis) with an oral antibiotic for 3 days.
  • Arrange imaging tests if indicated — this is seldom necessary in primary care because most infants and children who require imaging are already being managed in secondary care.
  • Refer for follow up in secondary care infants and children with:
    • Recurrent UTI.
    • Risk factors for serious underlying abnormality.
    • Atypical illness (e.g. inadequate response to treatment).
    • Abnormal imaging results.
  • Prophylactic antibiotics are rarely indicated and should not be initiated in primary care.
  • Urine culture for 'test of cure' after treatment is not routinely recommended.

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