URINARY TRACT INFECTIONS IN CHILDREN

- presence of a single pathogen in urine culture accompanied by clinical findings in

the history, physical examination and diagnostic evaluation

I. Acute Uncomplicated UTI

• Acute pyelonephritis
o Condition that indicates renal parenchymal involvement where infants
and children may present with fever with any or all of the following
symptoms: abdominal, back, or flank pain; malaise; nausea; vomiting;
and, occasionally, diarrhea.
o Infants and children who have bacteriuria and fever> 38°C OR those
presenting with fever <38°C with loin pain/tenderness and bacteriuria
should be worked up for acute pyelonephritis.
• •Acute cystitis
o condition that indicates urinary bladder involvement where infants and
children may present with any or all of the following symptoms of
dysuria, urgency, frequency, suprapubic pain, incontinence, and
malodorous urine.
o Patients usually have no systemic signs or symptoms.
 SUSPECTED URINARY TRACT INFECTION
URINALYSIS (SUGGETIVE OF UTI)
HISTORY (+) Leukocyte esterease or Nitrite Test
Bacteriuria present in urosepsis
PHYSICAL EXAMINATION Gram stained specimen
Pyuria – WBC/hpf or 10 mm3
(+) Urine Culture of properly collected
FEVER > 38.5 C urine specimen

ABSENT PRESENT

ORAL ANTIBIOTICS Admit to hospital

KUB UTZ, PRE AND POST VOID Parenteral antibiotics (IV/IM)
KUB UTZ, 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
POST VOID
Complete 7-14 days Reassess May shift to oral
antibiotics Repeat Urine Culture
of treatment Use appropriate antibiotic based Complete 7-14 days
on initial urine C&S (if available)
Complete 7-14 days of treatment

Antibiotic Prophylaxis
Renal Work up: Voiding Cystourethrogram or nuclear cystogram
When needed: Radionucleide renal scan ** (DMSA/DTPA)
Intravenous pyelography**
Other imaging techniques **
____________________________________________________
Urology follow up as needed
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Nephrology Follow up Urine Culture
Monitor Blood pressure GFR (Creatinine)
Urinalysis every 4-6 weeks
Management:
References:
National Antibiotic Guidelines 2017
Clinical Practice Guideline. In the Approach and Treatment of Urinary Tract Infection in
Children In the Philippine Setting

Marian H. Andal M.D.

Pediatrics