Urinary tract infections (UTIs) are common in children and should be suspected in any case of fever without focus, or in vomiting infants.
Acute UTI will not be covered in this guideline, please refer to the Royal Children’s Hospital clinical practice guidelines.
Recurrent UTI is diagnosed only after positive urine culture from an appropriate sample (see RCH CPG for further information). UTI cannot be diagnosed based on clinical symptoms alone, nor purely on dipstick. A positive urine dipstick should always be confirmed by urine culture and sensitivity.
- Recurrent UTI should only be diagnosed after positive urine culture from an appropriate sample.
- Prophylactic antibiotics for recurrent UTI remains controversial and should only be considered after referral to paediatric outpatient services.
- Recurrent UTI should be managed by treating the urinary tract infections acutely (see RCH CPG for further detail, including appropriate antibiotics), adjusting for the sensitivity of the organism.
- Prophylactic antibiotics for recurrent UTI remains controversial and should only be considered after referral to paediatric outpatient services.
- Imaging with renal USS should be performed in any child < 6 months old with a single UTI, or in any child with recurrent UTI - refer to paediatric outpatient services if renal tract anomalies are found.
- Paediatrician
- Unwell children or children < 6 months old with acute UTI, or those with signs of pyelonephritis, should be sent to the Emergency Department for inpatient IV antibiotic therapy.
- Referral to paediatric outpatient services is appropriate in the management of recurrent (not single) UTI or if abnormalities of the renal tract are found on ultrasound.