Paediatric urinary tract infections

Demographics

Children under 11 aet: 3% ♀ 1% ♂.
In neonates, M>F

Presentation

Nonspecific (fever, crying, difficult to settle, vomiting)

Causes

Important to exclude structural anomalies.

Investigations

Dipstix urine shows leukocytes, nitrates.
Confirm with clean catch for MCS: >105/ml.

For all children: US kidneys. Consider KUB for obstruction. Prophylactic antibiotics for all until investigations completed.

<1 aet: DMSA, MCUG.
1–5 aet: if US abnormal, DMSA (renal scarring). If DMSA abnormal, MCUG or MAG3 (looking for reflux).

Management

Amoxycillin ×5/7 (or 10/7 if systemically unwell).

Conservative

Prevent future UTI's:
  1. Drink lots of fluids
  2. Frequent micturition
  3. Double voiding
  4. Perineal hygiene

Medical

For recurrent UTI's or reflux:
  1. Mandatory urine cultures for every systemic illness
  2. Prophylactic antibiotics (trimethoprim)
  3. ?Circumcision

Surgical

Reimplantation of ureters if medical treatment fails.

Follow-up

If scarred kidneys, BP and U&E.