(Pediatrics 2011;128;595)
History
• Adolescents: Dysuria, urgency, frequency, hematuria; fever; flank pain, abdominal pain
• Younger children: Enuresis, foul-smelling urine, abdominal pain, nausea, vomiting
• Infants: Fever, irritability, poor feeding, vomiting, jaundice, FTT
Physical Exam
• Fever, suprapubic tenderness, bladder fullness; CVA tenderness; GU exam to assess for vaginitis
Evaluation
• Labs: UA/Ucx (may require straight cath for clean specimen); Chem 7 (dehydration), CBC/blood cultures (if considering sepsis)
• Renal U/S in febrile infant or young child b/w 2 mo & 2 yr w/ 1st UTI
• VCUG for recurrent infections, poor urinary stream, palpable kidneys, unusual organism, bacteremia or sepsis that fails to respond to abx, unusual presentation, or hydronephrosis/scarring seen on renal U/S
Treatment
• Supportive: Oral rehydration if child able to tolerate o/w establish IV for hydration
• Abx (usually E. coli):
• IV: Cefotaxime, ceftriaxone, gentamicin
• PO: Augmentin, Bactrim, cefixime, cefpodoxime
Disposition
• Home: Stable, tolerating POs, nontoxic appearing; PCP f/u in 2–3 d
• Admit: <2 mo old, toxic appearing, unable to tolerate POs, signs of urinary obstruction, suspected sepsis, underlying comorbidities, ↑ Cr