In general it is a good idea to be familiar with the clinical practice guidelines of the American Academy of Pediatrics. We see enough UTIs in the ED that it is always helpful to review.
Check it out here
The big take home points are:
- Diagnosis is MOST supported by pyuria and >50,000 colonies/mL on culture
- Follow up should occur at 7-14 days post treatment to document resolution
- In infants and toddler with first UTI they should undergo an outpatient ultrasound of the kidneys and bladder to identify congenital anomalies
- Data does not support starting urinary antibiotic prophylaxis in children with or without grade I to IV vesicoureteral reflux. Thus a Voiding Cystourethrogram – VCUG is not recommended after the first UTI as it had been previously. This latter issue has been somewhat controversial with some Urologists.
- If there are recurrent febrile UTIs then patients should have a VCUG
Here is a figure comparing probability of UTI in boys and girls – note the differences.
Check out the sensitivity and specificity of various portions of the chemical urinalysis test.
And finally, here are a number of different antibiotic choices – always consider local practice and resistance patterns when you make your choice.
