Urinary Tract Infection in the paediatric patient

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Management:
A presumptive diagnosis without microbiological confirmation should never be made. Clinical history should cover neonatal feeding and teething history, bowel and micturition habits including the stream in boys, previous history of UTI, family history of renal disease, UTT, hypertension and VUR.


Clinical examination should include BP estimation, palpation of the abdomen for renomegaly, bladder and large bowel, examination of the lumbosacral spine, lower limb reflexes and genitalia.

TREATMENT:

Delay in starting antibacterial treatment of urinary infection may lead to renal scarring. If symptoms are severe treatment should be started immediately after obtaining a urine specimen for culture.
Infants and children < 2 years should be hospitalized and treatment with parenteral antibiotics (Inj. Cefotaxime 100 mg/kg/day or Inj. Ampicillin 100 mg/kg/day with an aminoglycoside) should be started.
If the symptoms are mild or the diagnosis is in doubt treatment may be decided upon after seeing the culture report. In older children (>2 years) without vomiting oral drugs are prescribed. Suitable drugs and their dosages are listed in this table.

Drug Therapy mg/kg/d Prophylaxis mg/kg/d
Trimethoprim 4 1-2
Cefadroxil /
Cefaclor
25 -
Nitrofurantoin 5 1-2
Amoxycillin 20-25 -
Nalidixic Acid 25-50 15-20
Gentamycin 5-7 / IM -

Amoxycillin is better avoided especially if it has been prescribed recently eg, for a respiratory infection. Clinical response should be apparent within 48 hours. 5-7 days treatment is generally sufficient. Post treatment urine cultures should be sterile. Keep the patient on prophylactic antimicrobials until ureteral reflux and other predisposing factors are excluded.

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drmaverick 

Plz also add antibiotics of choice along with dosages.

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