Urinary Tract Infections (UTIS) in Children

Signs and Symptoms

In young children

• non- specific e.g. vomiting, fever, irritability, or failure to thrive

Older children:

• fever
• abdominal pain
• dysuria
• increased frequency of passing urine

Investigations

• Urine dipstick
• Urine microscopy and culture
• clean catch sample of urine
• In sick infants, suprapubic aspiration of urine may be required
• consider UTI if more than 5 white cells per high power field
• Blood culture
• LP if systemically unwell
• Indications for abdominal ultrasound scan in children with UTI:
• In all male infants with UTI
• Recurrent UTIs
• Abdominal mass or abnormal voiding
• Not responding to treatment

Treatment

<3 months Admit the child and treat with: Gentamicin Preterm 3mg/kg

Term neonate 5mg/kg >2 weeks :7.5mg/kg IV daily and Benzylpenicillin 50,000

IU/kg 12 hourly in first week of life then 6 hourly there after consider Blood Culture and Lumbar Puncture

Adjust antibiotics as guided by culture results

Second line:

Ceftriaxone 50mg/kg IV 24 hourly >3 months or older child with signs of systemic illness (T>38C, rigors, renal angle tenderness)

Admit and treat with Gentamicin 7.5mg/kg IV and Benzylpenicillin50,000 IU/kg IV ^ hourly or Ceftriaxone 50mg/kg IV 24 hourly

Change to oral antibiotic when fever settled and improving to complete 10 days treatment >3 months or older child with no signs of systemic illness

Treat with oral antibiotics Cotrimoxazole 10mg/kg every 12hrs for 3 days or Ciprofloxacin 10mg/kg 12 hourly for 5 days or Nitrofurantoin 1.5mg/kg 6 hourly for 5 days

Complications

• Renal scarring
• Chronic kidney disease

Complications and Referral Criteria

• Atypical UTI:
• Seriously ill
• Poor urine flow
• Abdominal or bladder mass
• Raised creatinine if measured
• Septicemia
• Failure to respond to treatment with suitable antibiotics within 48 hours
• Recurrent UTIs:
• 2 or more episodes of UTI with acute pyelonephritis/upper urinary tract infection
• One episode of UTI with acute pyelonephritis/upper urinary tract infection plus one more episode of UTI with cystitis/lower urinary tract infection
• Three or more episodes of UTI with cystitis/lower urinary tract infections