Pediatric UTI - Alaska

The following guidelines were prepared by the Alaska Antimicrobial Stewardship Collaborative (A2SC), and are reproduced here as a service to practitioners in the state.
These guidelines have not been reviewed or approved by the Sanford Guide Editorial Board.

Pediatric FEBRILE Urinary Tract Infection Treatment Guideline (2-24 months)

Symptoms

• Fever
• Poor feeding
• Vomiting
• Irritability
• Strong-smelling urine

Diagnostic Criteria for Acute Pyelonephritis

Urinalysis results that suggest infection

• Positive nitrite OR
• Leukocyte esterase OR
• Pyuria AND
• >50,000 CFUs per mL of a uropathogen cultured from a urine specimen obtained through catheterization or SPA

Risk Factors

• Girls
  • Age <12 months
  • Temp >39 C
  • Fever >2 days
• Boys
  • Temp >39 C
  • Fever >24 hours
  • Uncircumcised
• Absence of another source of infection

Test

• Obtain urine culture PRIOR to starting antibiotics

Treat

• Adjust therapy based on sensitivity testing

Imaging

• Renal/bladder ultrasound for 1st febrile UTI
• VCUG for 2nd febrile UTI or if abnormalities seen on renal/bladder ultrasound

Antibiotic Selection

Ambulatory Empiric Treatment

• Preferred Treatment
  • Cephalexin 50mg/kg/day PO divided TID or QID (max 4gm/day)
• Beta-lactam allergic
  • Sulfamethoxazole/trimethoprim 4-5mg/kg PO BID (trimethoprim component for dosing; max 160mg trimethoprim/dose)
• Duration of Therapy: 7-10 days

Inpatient Empiric Treatment

• Preferred Treatment
  • Ceftriaxone 50mg/kg IV Q24H (max 2gm/day)
• Beta-lactam allergic
  • Gentamicin 5mg/kg/day IV
• Duration of Therapy: 7-10 days

Reference

1. Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595-610.

Pediatric Urinary Tract Infection Treatment Guideline (>24 months)

Symptoms

• Preverbal
  • Fever
  • Abdominal/flank pain
  • Vomiting
  • Poor feeding
  • Lethargy
  • Malodorous urine
• Verbal
  • Frequency
  • Dysuria
  • Hesitancy
  • Urgency
  • Abdominal/flank pain

Risk Factors

• Prior history of UTI
  • Review prior organism/susceptibilities for guidance on empiric therapy selection if recurrent UTI
• Fever ≥ 2 days or prolonged ≥ 5 days

Test/Treat

• Obtain urine culture PRIOR to starting antibiotics
• Adjust therapy based on sensitivity testing

Antibiotic Selection

Ambulatory Empiric Treatment

• Preferred Treatment
  • Cephalexin 50mg/kg/day PO divided TID or QID (max 4gm/day)
• Beta-lactam allergic
  • Sulfamethoxazole/trimethoprim 4-5mg/kg PO BID (trimethoprim component for dosing; max 160mg trimethoprim/dose)
• Duration of Therapy: 7-10 days

Inpatient Empiric Treatment

• Preferred Treatment
  • Ceftriaxone 50mg/kg IV Q24H (max 2gm/day)
• Beta-lactam allergic
  • Gentamicin 5mg/kg/day IV
• Duration of Therapy: 7-10 days

Reference

1. Shaw K, et al. Pathway for the Evaluation and Treatment of Children with Febrile UTI. Children’s Hospital of Philadelphia. https://www.chop.edu/clinical-pathway/urinary-tract-infection-uti-febrile-clinicalpathway. Accessed Oct 2018.

Disclaimer

The Alaska Antimicrobial Stewardship Collaborative (A2SC) and all participating organizations and individuals assume no duty to correct or update these guidelines. Although efforts are made to include material within these guidelines that is accurate and represents the current best practice, there are no representations or warranties regarding errors, omissions, completeness or accuracy of the information provided. These guidelines are not an attempt to practice medicine or provide specific medical advice and should not be used to make a diagnosis or to replace or overrule a qualified health care provider's judgment.

Metadata
Adopted Nov. 2018 - Approved 2018