Urinary tract infection

Disclaimer These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.

Introduction

Urinary tract infections (UTI’s) are common in children. ^1,2

Urine samples must be a clean catch or catheter specimen, bag urines are not acceptable. ^1,2

The last decade has seen a significant change in the approach to the investigation and management of children following a first UTI. Both the National Institute for Health and Care Excellence and the American Academy of Paediatrics published guidelines that support a far less aggressive approach to the imaging of children with UTI's (i.e. infrequent use of micturating cystourethrogram and DMSA) and the cessation of routinely commencing prophylactic antibiotics and proof of cure urine samples. ^{1,2, 3, 4}

Pre-referral investigations

All children with a confirmed on laboratory microscopy, culture and sensitivity UTI should have a renal tract ultrasound. ^1,2,3,4 If the ultrasound is normal and the child had an E.Coli UTI, no further investigation is necessary. ^1,3,4

When to refer

• Children with an atypical (e.g. non E.Coli) UTI’s^1,4
• Children with recurrent UTI’s^1,4
• Children with an abnormal renal tract ultrasound.^1,4

References

1. National Institute for Health and Clinical Excellence, UTI guideline, UK
2. Urinary tract infection: Clinical Practice Guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. American Academy of Pediatrics 2011
3. http://www.nlm.nih.gov/medlineplus/ency/article/000505.htm
4. http://www.rch.org.au/clinicalguide/guideline_index/Urinary_tract_infection_guideline

Reviewer/Team:	Dr Andrew Martin, Charlotte Allen DGP CNS	Last reviewed:	Mar 2020
		Review date:	Mar 2022
Endorsed by:	Medical Advisory Committee (MAC)	Date:	Mar 2020

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