Pediatric Urinary Tract Infection Management

Comprehensive flashcards covering the diagnosis, clinical presentation, and empiric treatment of UTIs in pediatric patients based on the provided lecture transcript.

UTI with fever

Indicates an upper tract infection/pyelonephritis.

Cystitis

A urinary tract infection that is not usually accompanied by fever.

Clinical Signs in Infants/Non-verbal Children

Fever without apparent source, increased crying, vomiting, poor feeding, or other nonspecific symptoms.

Clinical Signs in Children > 2 years

Urinary symptoms such as dysuria, abdominal/back pain, new incontinence, and +/- fever.

Urinalysis (UA) - Normal Finding Rule

Do NOT send a urine culture if the UA is normal, as positive cultures are most likely contaminants.

Urine Microscopy Interpretation

Reports WBC per High Power Field (HPF) and supports diagnosis if leukocytes or nitrites are positive on UA.

Bagged Urine Specimen Rule

Used for urinalysis (UA) in infants, but should NEVER be sent for culture.

Urine Culture Storage Requirements

Ship to the lab ASAP (ideally within $4$ hours) or store in a refrigerator to avoid false positives.

Significant Growth (Catheter/Suprapubic)

$\ge 50 \times 106$ OR $\ge 50 \times 107\,CFU/L$ of a single uropathogen.

Significant Growth (Midstream)

$\ge 100 \times 106$ OR $\ge 100 \times 107\,CFU/L$ of a single uropathogen.

Clinical Diagnosis Criteria for UTI

Both a POSITIVE urinalysis (and pyuria on microscopy) AND a POSITIVE culture with significant growth.

Cephalexin Empiric Dosage

$75-100\,mg/kg/day$ PO divided TID or QID (MAX $4000\,mg/day$, or $1000\,mg/dose$).

TMP-SMX Empiric Dosage

$6-12\,mg$ of TMP component/kg/day PO divided BID (MAX $160\,mg$ TMP/dose).

Cefixime Empiric Dosage

$8\,mg/kg/day$ PO divided once daily (MAX $400\,mg/dose$).

Nitrofurantoin (as Macrobid®) Dosage

$100\,mg$ PO BID for $5$ days for afebrile well adolescents with cystitis.

Gentamicin or Tobramycin Dosage

$7.5\,mg/kg/day$ IV divided $q24h$ (MAX $360\,mg/day$ prior to levels).

Ceftriaxone Dosage

$50-75\,mg/kg/day$ IV divided $q24h$ (MAX $2000\,mg/dose$).

Uncomplicated Febrile UTI Treatment Duration

$7$ days.

Febrile UTI with Urological Abnormality Duration

$10$ days.

TMP-SMX Cystitis Duration

$3$ days.