Guidelines
Outpatient UTI - Febrile

Outpatient UTI - Febrile

This guideline applies to previously healthy children ≥ 2 months of age with no known preexisting renal structural abnormalities, renal dysfunction nor prior UTI with resistant pathogens.

The primary risk factor for UTI in children is CONSTIPATION which should always be addressed, even at first diagnosis. In adolescent years, sexual activity is also a risk factor.

Clinical criteria in preverbal children include fever and possibly irritability or crying with micturition. Children who are verbal usually complain of dysuria or frequency, new incontinence and may have back or flank pain.

Typically there is no other source of infection such as viral respiratory tract infection. Even children with bronchiolitis have a low risk of UTI (<1%).

Once clinical criteria are met, minimal laboratory diagnostic criteria for empiric treatment are positive nitrites and/or leukocyte esterase on urinalysis and/or pyuria (>5-10 WBC) on microscopy of urine.

It is very rare to have a urinary tract infection without pyuria. However, other conditions (e.g. fever from another infection, Kawasaki disease) may cause isolated pyuria without urinary tract infection.

Perform blood cultures, midstream or catheter urine for urine analysis AND microscopy, and culture.

Empiric Antimicrobials

Ensure clinical follow-up with a health care provider within 24 hours and accurate contact information to modify prescriptions according to culture results, if necessary.

In patients that will be discharged from ED

See Drug Monitoring section of cephalexin for information regarding sensitivity results for febrile UTI

AND

ALTERNATIVELY

Usual Duration

7 days of antibiotic to which the pathogen is susceptible.

As usual clinical response to antibiotics should be followed.

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