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Paediatric Treatment - Urinary Tract Infections

refer to PHE UTI guidance for diagnosis information
As E. coli bacteraemia in the community is increasing ALWAYS safety net and consider risks for resistance1 C

People >65 years; do not treat asymptomatic bacteriuria: it is common but is not associated with increased morbidity1 B+

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 (NICE & SIGN guidance).

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 - first Line
co-amoxiclav 1 A

See BNFc

7-10 days1 A

Upper UTI - second Line
cefixime2 A

See BNFc

7-10 days1 A

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).