Urinary tract infections (UTI) in children

Complicated UTI:

Younger children

Pyelonephritis

High fever, sick child

Needs- Antibiotics 10-14 days

Risk of scarring is high

Needs investigations & long term follow up

Uncomplicated UTI

Older children

Cystitis, urethritis

Dysuria, urgency, frequency, urge incontinence

Needs antibiotics for 7 days

Risk of scarring is minimal

No further investigation or long term care

Before Starting antibiotics in a febrile child Please collect urine first

Urine Routine: Pyuria, Bacteriuria, hematuria

Dip Stick: Nitrite test , Leukocyte esterase test

Urine C/S: Mid stream sample, Catheterization, Suprapubic aspiration

For Diagnosis of UTI ( Urine Routine )

Pus cells > 5 /hpf in centrifuged sample

For Diagnosis of UTI ( Urine C/S )

Single pathogen

Colony count > one lac in mid stream sample

Any growth in supra pubic aspirate

Avoid bag specimen for C/S

 

MCU

Must be done in children < 2 yrs with febrile UTI 2-5 yrs do MCU if renal scars+

DMSA

Detects renal scars 3 months post UTI No bowel preparation needed No radio contrast Should be done for children with febrile UTI

Treatment of Pyelonephritis

Initial Broad spectrum

Modify as per C/S

For 10-14 days

Prophylaxis

For recurrent UTI, VUR

Till 5 yrs of age

No need to rotate drugs

VUR

Frequent & Complete voiding

Double Voiding

Medical V/S Surgical treatment

Screen other sibling

USG

Cheap Easily Available Done for all febrile UTI