Prophylaxis of paediatric urinary tract infections guidance

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This guidance is designed for use by the A&E department and General Paediatrics to guide the decision regarding the use of antibiotic prophylaxis in preventing further febrile UTIs in a child presenting with a UTI. This guidance does not apply to patients already known to nephrology or urology services who should be discussed with these services if the question of prophylaxis arises.
The routine use of antibiotic prophylaxis after UTI’s is no longer recommended by NICE (2015), the
American Academy of Pediatrics (2011), and the Canadian Pediatric Society (2015) due both to the
lack of efficacy in preventing renal damage and the increasing prevalence of antibiotic resistance.
  1. Antibiotic prophylaxis after a UTI is not routinely recommended.

  2. Children/infants presenting with either an atypical UTI’s (seriously unwell, failure to respond within 48hrs, raised creatinine, abdominal/bladder mass) particularly in the under 6 month old or recurrent UTI’s should be discussed with either nephrology/urology with consideration of early imaging. Prophylaxis will be discussed on an individual basis.

  3. Whether antibiotic prophylaxis is prescribed or not parents and GP should be aware that the child may have further UTI’s and that subsequent symptoms suggestive of a UTI should:

    a) should result in the collection of a sample of urine for microbiological testing
    b) the consideration of early empiric antibiotic treatment if clinically warranted
    c) the pursuit of the urine test result and rationalisation of antibiotic prescription based on that result

  4. Where antibiotic prophylaxis is prescribed the risks/benefits should be discussed with parents and should be reviewed after 3-6 months with a view to stopping.

  5. Where antibiotic prophylaxis is prescribed, trimethoprim is the first line choice antibiotic. The usage of broad spectrum antibiotics e.g. co-amoxiclav or cefalexin should be avoided or used for a short period only in select cases. If a child’s UTI is trimethoprim resistant then consideration should be given to adopting an early empiric managment approach (see (3) above). Unfortunately liquid nitrofurantoin is currently £460 per bottle and its use as prophylaxis should be in exceptional cases only.
Editorial Information

Last reviewed: 27 November 2017

Next review: 30 November 2020

Author(s): Ysobel Gourlay

Version: 1

Approved By: Antimicrobial Utilisation Committee