Urinary Tract

Delay in starting treatment is associated with increased risk of scarring. All children under 3 years of age who have not achieved day time continence, who have signs of an upper urinary tract infection require prophylaxis after treatment, and referral to the UTI clinic for further imaging.

Suprapubic or clean-catch urine is required for diagnosis.

Treatment is followed with prophylaxis.

All children aged < 6 months with systemic illness should be treated with intravenous therapy initially.

Always review your choice of antibiotic as soon as cultures and sensitivities are available.

Seek senior paediatric advice

1st Line:

Co-amoxiclav IV

2^nd line:

Amoxicillin IV

Plus

Gentamicin IV

If true penicillin allergy:

Cefotaxime IV

OR

Ciprofloxacin IV (review MHRA Safety Advice before prescribing)

Co-amoxiclav IV is appropriate initial therapy in moderately unwell infants. If more severely unwell, gentamicin plus amoxicillin may be appropriate (the combination of gentamicin and co-amoxiclav duplicates Gram negative cover and is not required)

Duration: 3-5 days IV therapy initially, followed by 5 days oral therapy when tolerated.

Seek specialist advice from Microbiology

Urine must be sent for culture.

"Uncomplicated" infection equates to cystitis with no evidence of upper urinary tract infection, or of systemic upset.

Delay in starting treatment is associated with increased risk of scarring. All children under 3 years of age who have not achieved day time continence, who have signs of an upper urinary tract infection require prophylaxis after treatment, and referral to the UTI clinic for further imaging.

Send urine specimen for culture prior to initiating treatment if possible.

If there is no clinical improvement by 48 hours repeat urine culture and consider other urgent investigations

Stop prophylactic antibiotics during treatment and review sensitivities before re-commencing.

Always review your choice of antibiotic as soon as cultures and sensitivities are available.

Avoid prescribing trimethoprim when there is known pre-existing renal disease.Treatment

Trimethoprim PO

Or

Cefalexin PO

Duration: at least 3 daysUTI post-urological surgery

Seek specialist advice from Microbiology

Urine must be sent for culture.

"Complicated" infection equates to upper urinary tract infection (including pyelonephritis) or any patients with urinary tract symptoms and features of systemic upset.

Delay in starting treatment is associated with increased risk of scarring. All children under 3 years of age who have not achieved day time continence, who have signs of an upper urinary tract infection require prophylaxis after treatment, and referral to the UTI clinic for further imaging.

Send urine specimen for culture prior to initiating treatment if possible

If there is no clinical improvement by 48 hours repeat urine culture and consider other urgent investigations

Consider multi-drug resistant organisms in those with relevant travel history or previous resistant culture results

Always review your choice of antibiotic as soon as cultures and sensitivities are available.

1^st line:

Co-amoxiclav IV

2^nd line: 

Amoxicillin IV

Plus

Gentamicin IV

Co-amoxiclav IV is appropriate initial therapy in moderately unwell infants. If more severely unwell, gentamicin plus amoxicillin may be appropriate (the combination of gentamicin and co-amoxiclav duplicates Gram negative cover and is not required)

If true penicillin allergy:

Ceftriaxone IV

OR

Ciprofloxacin IV (review MHRA Safety Advice  before prescribing)

Duration: 7 days.  Consider longer treatment duration if still symptomatic

Seek specialist advice from Microbiology

Urine must be sent for culture.

If true penicillin allergy:

Clarithromycin oral

OR

Erythromycin oral

(Use Erythromycin with caution - risk of hypertrophic pyloric stenosis, particularly in the first few weeks of life)

Duration: 5-7 days

Mebendazole oral

May be used for children aged over 6 months old in combination with hygiene measures. A second dose may be required after 2 weeks.