Urinary Tract Infections

Microbiology

History and Examination

Consider UTI in an infant or child presenting with the following symptoms and signs:

Remember

Important points in history

Important points on examination

Diagnosis

Interpretation of dipstick results

Leucocyte esterase Nitrites Interpretation and action
Positive Positive UTI Start antibtiotic treatment for UTI
Negative Positive Likely UTI Start antibiotic treatment for UTI if fresh sample was tested
Positive Negative Unlikely UTI If possible obtain urine microscopy Only start antibiotic treatment for UTI if there is good evidence of UTI Result may indicate infection elsewhere
Negative Negative Very unlikely UTI Do not start treatment for UTI Explore other causes of illness

Interpretation of dipstick results is less valid in younger children, especially infants, often false negative test

Complication

Differential diagnossis

Admission criteria

Treatment

<3 months

3 months or older and has signs of systemic illness

>3 months or older with no signs of systemic illness

Supportive care

The child should be encouraged to drink or breastfeed regularly in order to maintain a good fluid intake, which will assist in clearing the infection and prevent dehydration.

Further investigations and Follow-up

Children with the following require further investigations:

Investigations:

All children who have had a UTI should be advised to get their urine checked if they become unwell.

Children with abnormalities should be followed up in General Clinic - Wednesday 1:30pm.

Prophylactic treatment if

Either Cotrim 2 mg TMP/kg as a single daily dose or Nitrofurantoin 1 to 2 mg/kg as a single daily dose for six months, than reasses