Treatment Plan

Treatment Plan

< 3 months:

• Admit to paediatrics
• IV antibiotics

3 months with lower UTI:

First line:

• Nitrofurantoin/trimethoprim for 3 days

Second line:

• Either one of the 1^st line options if not already used
• Amoxicillin for 3 days
• Cefalexin for 3 days Pyelonephritis > 3 months:
• Consider admission
• Cefalexin or co-amoxiclav (if culture available)

Follow up:

• Reassess within 48 hours
• If no improvement: consider differentials/referral/ultrasound.

Recurrent UTI management:

• Refer if > 3 months
• Treat current infection
• Consider 6-month prophylaxis o First line: nitrofurantoin/trimethoprim o        Second line: amoxicillin/cefalexin

Imaging:

During active infection:

• Ultrasound if atypical UTI

Within 6 weeks:

• Ultrasound if first UTI < 6 months responding to antibiotics
• Ultrasound if Non-E. Coli UTI without atypical features

DMSA scan:

• 4-6 months post-infection if < 3 years with atypical UTI

Prognosis

Generally good

Complications: Acute:

• Pyelonephritis

Chronic:

• Hypertension
• Renal scarring