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Urinary Tract Infections

The most common causes in children are E.coli (80%), Proteus, and Klebsiella.


A UTI in babies may indicate that they have an obstructive anomaly or Vesico-ureteric reflex/VUR (urine flows back into ureters and kidneys). A VUR is diagnosed by a Micturating Cystourethrogram (MCUG).


Presentation

The main symptom in younger children is a Fever.


Babies present with non-specific symptoms, such as Lethargy, Irritability, Vomiting, Poor feeding, Frequency (having to change wet nappies more often).


Older children present with the more specific symptoms that one would expect with a UTI, such as Abdominal pain, Dysuria, Vomiting, Frequency, Haematuria.


Investigations

  • MSU for Urine dip and MC&S – Nitrites and Leukocytes


Management

  • If < 3 months - refer urgently to a paediatric specialist

  • If > 3 months:

    • Pyelonephritis - Cefalexin or Co-amoxiclav

    • Cystitis – Trimethoprim (1st line), Nitrofurantoin (2nd line), Amoxicillin, or Cefalexin


Recurrent UTI

This is defined as 2+ episodes of pyelonephritis OR 1 episode of pyelonephritis + 1+ episode of cystitis OR 3+ episodes of cystitis.


Investigations

  • US

  • DMSA – Checks for scarring as this area won’t take up any of the injected material

  • MCUG – Check for VUR (backflow of urine)


Management - Prophylactic antibiotics




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