UTI is a common bacterial infection causing illness in infants and children. It may be difficult to recognise in children because the presenting symptoms and signs are non-specific, particularly in infants and children under three years.
KEY RECOMMENDATIONS FOR PRIMARY CARE
Patients with unexplained fever (>38°C) or symptoms suggestive of UTI should have a urine sample tested for infection. Perform urine test no later than 24 hours in patients with unexplained fever.
A clean catch urine sample should be used – if this is not possible, use a urine collection pad. Cotton wool balls, gauze or sanitary towels should not be used.
The following risk factors for UTI and serious underlying pathology should be recorded:
- Poor urine flow.
- History of UTI.
- Recurrent fever of uncertain origin.
- Antenatally diagnosed renal abnormality.
- History of vesicoureteric reflux or renal disease.
- Dysfunctional voiding.
- Enlarged bladder.
- Abdominal mass.
- Evidence of spinal lesion.
- Poor growth.
- High blood pressure.
Infants <3 months with a possible UTI:
- Refer immediately to a paediatric specialist.
Infants and children >3 months with acute pyelonephritis/upper UTI:
- Consider referral to a paediatric specialist.
- Treat with oral antibiotics for 7—10 days; use antibiotic with low resistance pattern.
- If oral antibiotics cannot be used, use IV antibiotics such as cefotaxime or ceftriaxone for 2—4 days, followed by oral antibiotics for a total of 10 days.
Infants and children >3 months with cystitis/lower UTI:
- Treat with oral antibiotics for three days. Choice of antibiotic should be directed by local guidance; trimethoprim, nitrofurantoin, cephalosporin or amoxicillin may be suitable.
- If the child is still unwell after 24—48 hours, reassess.
- If no alternative diagnosis, send urine for culture.
Antibiotic prophylaxis is not routinely recommended in infants and children following first-time UTI.
The full guideline is available at http://www.nice.org.uk/.