Urinary Tract Infection

Febrile infants below 3 months should always be discussed with paediatricians.

Early diagnosis and treatment of UTI is especially important in febrile children below 2 years as delayed treatment can scar the kidney.

While urine dipstick is helpful, we recognise that in children below 3 years, this may not be sensitive enough and we would usually ask for a urine mc+s from a clean catch.

Then should we start treatment while we await urine cultures ?

Should they be referred to the hospital for assessment and iv treatment ?

IV treatment is recommended for UTI where there is high fever over 39 degrees and look ill and be considered if there is known urological abnormalities or there is a lot of vomiting.

In primary care the UTI calculator can be useful to help decide of we can wait for urine culture before starting antibiotics or we need to start antibiotics empirically. It also has an initial step of whether a urine sample should be obtained which would be helpful in primary care.

If there is high probability of UTI but the child is at low risk of renal damage, fever less than 39, no vomiting, relatively well looking and no known urological anomalies or previous uti, it would be reasonable to treat with oral cephalexin while awaiting cultures and if positive then treat for 10 days.

Febrile UTI in the very young are to be considered as pyelonephritis ( in my view) and should be treated with 10 days of cephalexin rather than 3 days of trimethoprim.

For decision support, do see the UTI calc UTI calc, the first step will suggest if a urine dip and urine culture is indicated, the second step will suggest if treatment should be started while awaiting urine culture results.