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UTI is best defined as the presence of a significant level of bacteria in the urinary tract in the presence of an inflammatory response. Clinically, UTIs can be grouped into:
Age | Most common | Less common | Least common |
Less than 3 months | Unexplained fever Vomiting Lethargy Irritability | Poor feeding Faltering growth | Abdominal pain Jaundice Haematuria Offensive urine |
Preverbal (infants & toddlers) | Fever | Abdominal pain Loin tenderness Vomiting Poor feeding | Lethargy Irritability Haematuria Offensive urine Faltering growth |
Verbal (older children) | Frequency Dysuria | Dysfunctional voiding Deterioration in continence Abdominal pain Loin tenderness | Fever Malaise Vomiting Haematuria Offensive/cloudy urine |
Notes
Other common sources of fever in children including serious bacterial or viral infections
Adapted from NICE fever in children guidelines
Colour
Activity
Respiratory
Circulation
Other
Dipstick | Nitrate positive | Nitrite negative |
Leukocyte esterase positive | Likely UTI, send for MC&S, start treatment | Treat if UTI clinically likely, but may indicate infection elsewhere |
Leukocyte esterase negative | Suspect UTI if freshly voided sample, send for MC&S, start treatment | UTI unlikely |
Notes
Infection | Antibiotics BNFc for dose | Course length | Comments |
Younger than 3 months | Refer acutely to general paediatrics | ||
Older than 3 months Upper tract UTI | Oral Co-Amoxiclav | 7-10 days. Assess response after 24-48 hours. Check culture result in non-responders | Consider referral to general paediatrics for intravenous treatment if severely unwell/not tolerating oral |
Older than 3 months Lower tract UTI | Oral Trimethoprim Alternatives are Nitrofurantoin or Co-Amoxiclav | 3 days. Assess response after 24-48 hours. Check culture result in non-responders |
Prevent further UTIs by
For treatment choices please refer to North and East Devon Formulary:
Joint Formulary - Chapter 5 - Urinary Tract Infections
3-6 months
6 months – 3 years
Greater than 3 years
e-Referral Service details:
NICE Feverish Illness in Children younger than 5
This guideline has been signed off on behalf of NHS Devon.
Publication date: December 2016