Empiric treatment of paediatric UTIs

exp date isn't null, but text field is

Objectives

Paediatric urinary tract infections (UTIs) are becoming more problematic to manage clinically due to increasing levels of antimicrobial resistance. The following guidance is intended to promote patient safety, optimise clinical management and minimise usage of antimicrobials through encouraging the appropriate collection of urinary samples, the prescription of appropriate empiric antimicrobials and the timely chasing of urine culture results.

If a child is known to the renal service or has had previous UTIs then please check previous urine culture results as this may influence empiric prescribing.

1. Urine culture is advised for all infants, children and adolescents for whom empiric antibiotic treatment for a UTI is considered

2. The following empiric treatment is advised. Please record duration of treatment on Kardex if admitted

Upper tract UTI/pyelonephritis 

  • Fever above 38°c and significant systemic upset or  under 6 months of age

 

 

 

 

 

  • I.V. ceftriaxone +/- gentamicin
    Switch to oral antibiotics when appropriate (guided by sensitivities)  Total duration: 10 days.

    Gentamicin may be used in combination with ceftriaxone initially in very unwell patients after checking a serum urea and creatinine. Gentamicin usage should be reviewed daily and a gentamicin monitoring form should be completed.

    Penicillin allergy: use gentamicin initially and discuss with micro or ID
  • Fever above 38°c and mild systemic upset and tolerating oral antibiotics and over 6 months of age
  •  Oral co-amoxiclav
    Penicillin allergy: ciprofloxacin
    Duration: 7 days

Cystitis 

  • Frequency, dysuria with no systemic upset or fever, nitrite negative
  • Await urine culture result
  • If nitrite positive or significant symptoms/concerns re lower UTI and no fever
  • Oral co-amoxiclav 
    Penicillin allergy: nitrofurantoin*.
    Duration 3 days

 

*Nitrofurantoin is contrainidicated in patients under 3 months of age. Please contact microbiology or ID for advice for suitable alternative.

3. For those patient’s discharged from the Emergency Department, advise the child’s parent/carer that the child should be improving within 48 hours. If the child is not improving or is clinically worsening, then the child should present to the GP. Issue the UTI factsheet to parents and carers.

4. Most urine sample cultures will be reported at 48 hrs and all effort should be made to chase these results and amend the clinical management plan accordingly. If a bacterium grows which is resistant to the prescribed antibiotic, then contact the patient’s parent/carer to check the clinical progress. If the child remains symptomatic, then change antibiotic as per sensitivities.

Editorial Information

Last reviewed: 27 November 2017

Next review: 30 November 2019

Author(s): Ysobel Gourlay

Approved By: Antimicrobial Utilisation Committee