1. UTI in Children NICE Guidelines Mary Conroy

2. Common condition May present with non specific symptoms Sequelae, heavy burden on NHS

3. Diagnosis < 3 months Fever Vomiting Lethargy Poor feeding/FTT Abdominal pain /jaundice/haematuria/offensive urine

4. Diagnosis > 3 months Preverbal Fever Abdominal/loin pain Vomiting Lethargy FTT Haematuria Offensive urine Verbal Frequency Dysuria Dysfunctional voiding Changes to continence Pain Cloudy/offensive urine

5. When to test urine with symptoms and signs of UTI with unexplained fever of 38°C or higher (test urine after 24 hours at the latest). with an alternative site of infection but who remain unwell (consider urine test after 24 hours at the latest).

6. Collecting the urine sample A clean catch urine sample is the recommended method for urine collection. – use other non-invasive methods such as urine collection pads. – do not use cotton wool balls, gauze or sanitary towels. If other non-invasive methods are not possible: – use a catheter sample or suprapubic aspiration Do not delay treatment if the sample cannot be obtained and the infant or child is unwell

7. Under 3/12 0 refer to paeds 3/12 – 3 years – urgent miscroscopy and culture + Abx or MC&S + Abx

8. Microscopy Pyuria Positive Pyuria Negative Bacteriuria Positive Treat Bacteriuria Negative Treat on clinical grounds No treatment needed

9. Urine dipstick Nitrite Positive Nitrite Negative Leukocyte Positive Treat MC&S Treat on clinical grounds MC&S Leukocyte Negative Treat if fresh sample - MC&S No treatment required

10. Management Under 3/12 refer Upper UTI/Pyelonepritis, consider referral Cef or Augmentin 7-10 days Lower UTI, oral antibiotics 3 days eg trimethoprim, nitrifurantoin, amoxicillin

11. Prevention Hydration Try not to delay voiding Address dysfunctional elimination syndromes and constipation

12. Investigation < 6/12 Typical UTI (responds to Tx 48hr) - US within 6 weeks Atypical UTI/ Recurrent UTI - US during acute infection, DMSA, MCUG

13. 6/12 – 3 years Typical UTI – nil Atypical UTI – US during acute infection DMSA Recurrent – US DMSA

14. Over 3 years Typical UTI – Nil Atypical UTI – US acute Recurrent UTI – US DMSA

15. Follow up Refer recurrent UTI and abnormal imaging Renal parenchymal defects – monitor height, weight, BP and proteinuria Long term follow up: bilateral renal abnormalities, impaired renal function, BP, proteinuria under paeds nephrologist to slow progression to CKD

16. Summary Consider UTI in the febrile child Refer <3/12, consider in upper UTI/Atypical UTI Typical UTI > 6/12 – no need for investigation