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Antimicrobials
In infants or children with a high risk of serious illness, treatment should not be delayed if a urine sample is unobtainable
Principles of treatment
The drug of choice should be based on sensitivity patterns of the uropathogens and history of recent antimicrobial treatment
The drug should have minimal adverse effects on the major organ systems
A high concentration of the drug should be present in the urine after administration
Oral antibiotics are efficacious in both lower and upper tract infections (Urinary antiseptics such as nalidixic acid and nitrofurantoin should NOT be the initial drug of choice in upper tract UTI)
Intravenous antibiotics indicated for
Infants < 3 months of age
Poor oral intake
Dilating vesicoureteric reflux grade III-V
Atypical or complicated UTI
UTI ± fever in a child ≥ 3 months of age with no complications
Identified by growth of a significant number of organisms of a single specimen of urine, in the presence of symptoms
Identified by (one or more):
UTI associated with sepsis or bacteraemia
Concern regarding obstructive uropathy e.g. poor urine flow, abdominal or bladder mass
Failure to respond to antibiotics within 48 hours
Associated impaired renal function e.g. raised creatinine
Infection with a non E. coli organism
Treat according to antibiotic sensitivity results
Atypical or complicated UTI: if indicated, amikacin is the aminoglycoside of choice as its nephrotoxic potential is lower than gentamicin
Ceftriaxone should be avoided in the first two weeks of life as it may affect bilirubin transport in the liver
