Guidance on urinary tract infection in children

on the 24 September 2007

The new guideline from NICE offers best practice advice on the care of infants, children and young people under 16 years with urinary tract infection (UTI).

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.
Constipation.
Dysfunctional voiding.
Enlarged bladder.
Abdominal mass.
Evidence of spinal lesion.
Poor growth.
High blood pressure.

Acute management
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/.