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Guideline
Guideline
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II.
THE FOLLOWING IS AN ALGORITHM ON THE DIAGNOSIS, WORK-UP, TREATMENT AND FOLLOW-UP OF CHILDREN WITH URINARY TRACT INFECTION SUSPECTED URINARY TRACT INFECTION
History Urinalysis (suggestive of UTI) (+) Leukocyte esterase or Nitrite Test Bacteria present in unspun Gram-stained specimen Pyuria WBC/hpf or 10/mm3 (+) Urine culture of a properly Collected urine specimen Physical Examination
FEVER 38.5 C
ABSENT
PRESENT
CBC (CRP, ESR) BUN, Creatinine Optimal CRP, ESR, Blood C/S
Admit to hospital Parenteral Antibiotics KUB Ultrasound, pre and post void Urology consult as needed
Reassess May shift to oral Repeat urine culture Complete 7-14 days Use appropriate antibiotics Based on initial urine C/S Complete 7-14 days of treatment
Antibiotic Prophylaxis Renal Work-up: Voiding Cystourethrogram Or nuclear cystogram Radionuclide renal scan (DMSA/DTPA) Intravenous Pyelography Other imaging techniques Urology follow-up as needed Nephrology follow-up Monitor Blood Pressure Urinalysis every 4-6 weeks Urine Culture GFR (Creatinine)
When needed:
III.
DIAGNOSIS i. HISTORY
History of previous proven UTI, constipation, voiding disorders such as incontinence, previous surgeries especially pelvic surgeries.
ii.
PHYSICAL EXAMINATON
Thorough physical examination is a must. The examiner should look for congenital defects that coexists. Back examination such as presence of dimples, hair tufts in the lumbosacral area indicating probable neurogenic bladders. Lower extremities must also be examined. Though neurologic examination must be included. Rectal examination is part of the examination.
iii.
URINALYSIS
Proper Collection of Urine: This is the cornerstone of the algorithm. >> Requirement a. For infants below one year of age, a suprapubic tap is recomended. b. A catheterized urine is good alternative to obtain urine specimen. c. Midstream urine collection for cooperative patients older girls, circumcised boys and older boys whose foreskin is easily retracted.
iv.
URINE CULTURE
THE GOLD STANDARD IS ANY BACTERIAL GROWTH AFTER A SUPRAPUBIC TAP.
CATHETERIZATION
IV.
WORK-UP
Ultrasonography alone as a work-up for patients with proven urinary tract infection is inadequate. The use of voiding cystourethrography (or nuclear cystogram) evaluates the presence or absence of vesicoureteral reflux.
V.
TREATMENT
Some Antibiotics for Parenteral Treatment of UTI - Ceftriaxone 75mg/kg every 24 hours - Cefotaxime 150mg/kg/day divided every 6 hrs - Ceftazidime 150mg/kg/day divided every 6 hrs - Cefazolin 50mg/kg/day divided every 8 hrs - Gentamycin 7.5mg/kg/day divided every 8 hrs - Tobramycin 5mg/kg/day divided every 8 hrs - Ticarcillin 300mg/kg/day divided every 6 hrs - Ampicillin 100mg/kg/day divided every 6 hrs
Some Antimicrobial for Prophylaxis of UTI - TMP-SMX Nitrofurantoin Sulfisoxazole Nalidixic Acid Methenamine mandelate
2mg TMP,10mg SMX per kg as single Bedtime dose 1-2mg/kg as single daily dose 10-20mg/kg divided every 12 hrs 30mg/kg divided every 12 hours 75mg/kg divided every 12 hours
In The Approach And Treatment Of Urinary Tract Infection In Children In The Philippine Setting