Clinical Practice Guideline In the Approach And Treatment of Urinary Tract Infection In Children In The Philippine Setting THE CHILD WITH PROBABLE URINARY TRACT INFECTION I. The SUSPECT 1. The neonates presenting with the clinical signs and symptoms as presented in table 1, 2. Febrile infants (>38 C) below 2 years of age. 3. Older children manifesting symptoms referable to urinary tract. Table 1 : Signs and Symptoms Associated with UTI Enuresis Flank pains vvvy ical Signs and Symptoms Neonates Older Infants | School Age Adolescents > Septic i) > Temperature instability [4] * Poor feeding (1 > Vomiting (4 4 > Lethargy/irritability [4 > Jaundice fea} > Fever 4] 4] Gl * Poor weight gain 4] (1 tia] > Diarrhea 4] > Abdominal Pain f ) > Frequency, dribbling, fea} 4] urgency, dysuria Weak urinary stream 4 ial Malodorous urine 4 2]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 2 WBC/hpf or 10/mm3 +— (4) Urine culture of a properly a Collected urine specimen Physical Examination FEVER 2 38.5C ¥ ¥ ABSENT PRESENT CBC (CRP, ESR) BUN, Creatinine Optimal CRP, ESR, Blood C/S ¥ ¥ Oral Antibiotics ‘Admit to hospital Parenteral Antibiotics KUB Ultrasound, pre and pastvold KUB Ultrasound, pre and post void Urology consult as neededGOOD RESPONSE POOR RESPONSE GOOD RESPONSE After 48-72 hours After 48-72 hours After 48-72 hours Complete 7-14 days of, Reassess May shift to oral of treatment Repeat urine culture Complete 7-14 days Use appropriate antibiotics Based on initial urine C/S Complete 7-14 days of treatment I Renal Work-up: When needed: Antibiotic Prophylaxis 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)