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Paediatric Treatment - Urinary Tract Infections

refer to PHE UTI guidance for diagnosis information. Note: As antimicrobial resistance and Eschericia coli bacteraemia is increasing, use nitrofurantoin first line. ALWAYS give safety net and self-care advice, and consider risks for resistance1 C. Give TARGET UTI leaflet.

Catheter in situ: antibiotics will not eradicate asymptomatic bacteriuria: only treat if systemically unwell or pyelonephritis likely2 B+
Do not use prophylactic antibiotics for catheter changes unless history of catheter-change-associated UTI or trauma3 B. Take sample if new onset of delirium, or two or more symptoms of UTI.

UTI in children

PHE Urine
NICE-CKS
NICE

Child <3 months: refer urgently for assessment 1 C
Child ≥ 3 months: use positive nitrite to guide
Start antibiotics, 1 A+ also send pre-treatment MSU for all.
Imaging: only refer if child <6 months, recurrent or atypical UTI 1 C

Medicine Calendar

Lower UTI: trimethoprim 1 A

See BNFc

3 days 1 A+

OR lower UTI: nitrofurantoin 1 A

See BNFc

3 days 1 A+

For Lower UTI,
if susceptible, amoxicillin 1 A

See BNFc

3 days 1 A+

For Lower UTI second line:
cefalexin 1 C

See BNFc

3 days 1 A+

Upper UTI: refer to paediatrics to: obtain a urine sample for culture;[1D] assess for signs of systemic infection;1D consider systemic antimicrobials.[1D]

Acute pyelonephritis

NICE-CKS

If admission not needed, send MSU for culture & sensitivities and start antibiotics 1 C
If no response within 24 hours, seek advice2 C

If ESBL risk, with microbiology advice consider IV antibiotics via outpatients (OPAT)6 C

Medicine Calendar

co-amoxiclav

See BNFc

7 days

OR ciprofloxacin

See BNFc

7 days

If lab report shows sensitive
trimethoprim3 A

See BNFc

14 days

The POCAST project is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London and by the Imperial College Healthcare Charity (Grant Ref No:7006/P36U).