• If the child is at high risk for serious illness — urgently refer/admit.
• If the child is at intermediate risk for serious illness — consider urgent referral/admission.

In depth

• If urinary tract infection (UTI) — upper or lower — is suggested by symptoms and supported by urine tests, then treat immediately with an antibiotic.
• Obtain a urine specimen for culture and sensitivities prior to starting antibiotics.
• Delay the decision about treatment until the urine microscopy and culture results are available, when there are no specific symptoms for UTI and:
• Either they are at intermediate risk for serious illness and the urine test does not suggest UTI,
• Or they are at low risk for severe illness (urine test is not needed).

In depth

• Treat with an oral antibiotic for 3 days.
• Consider trimethoprim, cefalexin, amoxicillin, or nitrofurantoin, while taking local bacterial sensitivity patterns into account (this is an off licence use of nitrofurantoin as the summary of product characteristics specifies 7 days).
• Note: avoid using broad spectrum antibiotics (e.g. cephalosporins) when narrow spectrum antibiotics are effective, as they increase the risk of Clostridium difficile, MRSA, and resistant UTIs.
• Treat pain with paracetamol — avoid NSAIDs.
• Encourage (and monitor) adequate fluid intake.

In depth

• Treat with an oral antibiotic for 7–10 days (provided that they do not require admission).
• Consider co-amoxiclav or cefalexin, while taking local bacterial sensitivity patterns into account.
• Treat fever and pain with paracetamol — avoid NSAIDs.
• Encourage (and monitor) adequate fluid intake.

In depth

• They should telephone or return to get the urine culture results when these are expected to be available.
• If the infant or child is still unwell after 24–48 hours, they should return for reassessment.
• Once the infant or child has recovered, they should be alert to the uncommon possibility of a repeat urinary tract infection (UTI). If they suspect a repeat UTI, they should seek medical assessment without delay.
• Infants and children who are 6 months or older, who respond well to treatment and do not have any other unusual features, do not need any further tests unless they have further UTIs.

In depth

• Routinely review with the culture result (e.g. at around 48 hours). This can be done by telephone, but if the infant or child is not responding, they should be brought in for reassessment.
• If the infant or 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.
• Refer urgently to a paediatric specialist if the infant or child has:
• Poor response to appropriate treatment.
• A history or clinical features suggesting urinary tract obstruction.
• Refer non-urgently to a paediatric specialist if the infant or child:
• Is less than 6 months old.
• Has had a previous urinary tract infection.

In depth