1. UTI Referrals Dr Rick Fulton 09/06/2014

2. UTI NICE guidelines Definitions When to refer

3. NICE Guidelines Upper vs lower UTI – Fever >38 C = upper (7- 10d antibiotics) <3y old if microscopy does not show WC in urine but culture is positive = treat as UTI <3m old with UTI – refer ALL acutely

4. Definitions Atypical UTIRecurrent UTI Seriously illTwo or more episodes of UTI with acute pyelonephritis/ upper urinary tract infection Failure to respond to treatment with suitable antibiotics within 48 hours One episode of UTI with acute pyelonephritis/upper urinary tract infection plus one or more episode of UTI with cystitis/lower urinary tract infection Abdominal or bladder massThree or more episodes of UTI with cystitis/lower urinary tract infection Raised creatinine Septicaemia Poor urine flow Infection with non-E. coli organisms

5. NICE Guidance Imaging – Consider if recurrent or atypical UTI (recurrent = 2 or more) <6m – if atypical or recurrent – USS, DMSA, MCUG (if typical = USS only) 6m-3y – if atypical or recurrent – USS, DMSA >3y – if atypical or recurrent – USS (consider DMSA)

6. Referrals Refer if atypical or recurrent in <6m Suggest referral if atypical or recurrent 6m-3y Consider referral if USS abnormal in >3y

7. References Urinary Tract Infection in Children. NICE Guidelines. CG 54. 2007. Hascombe guidelines.