Pediatric Guidelines: Urinary Tract Infections - Community Onset

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Diagnosis of UTI in most patients requires a positive urinalysis and urine culture with comptable urinary tract symptoms

Ensure appropriate collection methods (catheterization or clean catch). 

Therapy should be modified according to culture and susceptibilities. 

For patients with prior UTIs, consider prior causative organisms when selecting empiric therapy. 

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Urinary tract infection, community-onset, 2 months-12 years old, outpatient therapy Enteric Gram negatives

Patient without significant recent antibiotic exposure or known urinary tract abnormalities:

Cephalexin 25mg/kg/dose PO TID (max 500mg/dose)

Beta lactam allergy:

Trimethoprim-sulfamethoxazole (Bactrim/Septra) 4mg/kg/dose trimethoprim PO BID (max 160mg trimethoprim/dose)

For infants < 2 months, refer to Fever Without a Source section for initial therapy then narrow based on organism and susceptibilities

Duration:

UTI without fever: 7 days

UTI with fever in younger child: 10 days

See Antibiogram for outpatient E. coli susceptibilities

If significant prior antibiotic exposure or urinary tract abnormalities:

Cefdinir 14mg/kg/dose PO daily (max 600mg/day)

Uncomplicated cystitis, > 12 years old, outpatient therapy Enteric Gram negatives Nitrofurantoin monohydrate/macrocrystals (Macrobid) 100mg/dose PO BID Cephalexin 25mg/kg/dose PO BID (max 500mg/dose) Duration: 5 days
Pyelonephritis, community-onset, inpatient therapy  Enteric Gram negatives 

Inpatient:

Ceftriaxone 50mg/kg/dose IV q24h (max 1g/dose)

Beta lactam allergy:

Ciprofloxacin 15mg/kg/dose IV/PO BID (max 400mg/dose IV, 500mg/dose PO)

 

ID consult recommended for complicated infection or concurrent bacteremia

Duration: 

Beta lactams: 10-14 days

Ciprofloxacin: 7 days

 

If candidate for PO therapy:

Cefdinir 14mg/kg/dose PO daily (max 600mg/day)

References:

American Academy of Pediatrics Subcommittee on Urinary Tract Infection. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.      

Gupta K, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103-e120.

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).