# Urinary tract infection in children - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Urinary Tract Infections In Children - StatPearls (NCBI Bookshelf NBK599548) - https://www.ncbi.nlm.nih.gov/books/NBK599548/ · Urinary tract infection in under 16s: diagnosis and management - NICE Guideline NG224 (NCBI Bookshelf NBK588844) - https://www.ncbi.nlm.nih.gov/books/NBK588844/ · Urinary tract infection in children - disease-level clinical article (paediatric-uti-full.txt) · Urinary tract infection in children - disease-level clinical article (paediatric-uti-clinical.txt) - Verified date: 2026-08 ## Verified against - Urinary Tract Infections In Children - StatPearls (NCBI Bookshelf NBK599548) - https://www.ncbi.nlm.nih.gov/books/NBK599548/ - Urinary tract infection in under 16s: diagnosis and management - NICE Guideline NG224 (NCBI Bookshelf NBK588844) - https://www.ncbi.nlm.nih.gov/books/NBK588844/ - Urinary tract infection in children - disease-level clinical article (paediatric-uti-full.txt) - Urinary tract infection in children - disease-level clinical article (paediatric-uti-clinical.txt) ## Treatment metadata - Cephalexin — 250 mg — oral.liquid - Amoxicillin + Clavulanic acid — 457 mg — oral.liquid - Ceftriaxone — 500 mg — injection - Referral & safety-netting (no drug therapy) - Nitrofurantoin — 50 mg — oral.liquid ## Complete treatment card ```text URINARY TRACT INFECTION IN CHILDREN Sources: Urinary Tract Infections In Children - StatPearls (NCBI Bookshelf NBK599548) - https://www.ncbi.nlm.nih.gov/books/NBK599548/ · Urinary tract infection in under 16s: diagnosis and management - NICE Guideline NG224 (NCBI Bookshelf NBK588844) - https://www.ncbi.nlm.nih.gov/books/NBK588844/ · Urinary tract infection in children - disease-level clinical article (paediatric-uti-full.txt) · Urinary tract infection in children - disease-level clinical article (paediatric-uti-clinical.txt) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - In the first three months of life, UTI can show up as fever, vomiting, low temperature, jaundice, poor feeding, faltering growth, or irritability [failure to thrive · fever · irritability · jaundice · poor feeding · vomiting] - Under age 2, symptoms are vague and often reported late because the child cannot localize the pain; unexplained fever is the most common presentation [fever] - Urethritis presents with painful urination, itching, or discharge from the urethra [burning on passing urine · itching · urethral discharge] - Cystitis presents with painful, urgent, or frequent urination, cloudy or foul-smelling urine, and suprapubic pain [abdominal pain · cloudy urine · lower abdominal pain · urinary frequency] - Pyelonephritis presents with fever, flank pain, belly pain, vomiting, or other systemic symptoms [abdominal pain · fever · loin pain · vomiting] - A history of constipation, voiding dysfunction, prior UTI, or recent antibiotics is relevant to ask about [constipation] - It is one of the commonest bacterial infections of childhood - It starts when bacteria climb up from the urethra into the urinary tract SIGNS - what you find (1) - Exam findings can include a distended abdomen or bladder, a flank mass from hydronephrosis, palpable stool, or costovertebral or suprapubic tenderness [abdominal distension · abdominal pain · lower abdominal pain] TESTS (12) - Dipstick testing only rules infection in or out reliably when nitrite and leukocyte esterase are read together - Blood or protein on the dipstick is not a dependable sign of UTI - Bagged urine specimens should only be sent for urinalysis, not culture, because skin bacteria can contaminate the sample - More than 5 white cells per high-power field, or 25 per microliter, on microscopy is abnormal and strongly suggests UTI in a symptomatic child - The culture threshold for infection depends on collection method - over 100,000 CFU/mL for midstream, over 50,000 for catheter, and over 1,000 for suprapubic aspiration - Renal ultrasound is recommended for every young child's first febrile UTI, and for older children with recurrent infection - Upper tract means the kidneys and the ureters; lower tract means the bladder and the urethra - The three names by site: urethritis when only the urethral lining is involved, cystitis when it is the bladder, and pyelonephritis once it has climbed to the kidneys - Bacteria can sit in the urinary tract causing neither inflammation nor symptoms, and that is asymptomatic bacteriuria - Sterile pyuria is raised white cells in the urine with nothing growing on culture - It counts as a complicated UTI in a newborn, in urosepsis, or where there is a mass in the bladder or the abdomen - It also counts as complicated with a congenital anomaly of the kidneys or urinary tract, an organism other than Escherichia coli, a renal abscess, an atypical course, or 72 hours of an antibiotic without clinical response IF NOT THIS - what else fits (4) - Viral infection is on the differential list - Renal stones can mimic the presentation and should be considered - Appendicitis is on the differential, especially with lower abdominal symptoms - Orchitis and epididymitis should be considered in boys with a similar presentation Source Urinary tract infection in children - disease-level clinical article (paediatric-uti- full.txt) Status traced to the source above Rx: Antibiotic | Main treatment ANTIBIOTIC - choose one 1. CEPHALEXIN [1st line] Adult 250-1,000 mg every 6 hours, or 500 mg every 12 hours (maximum 4 g/day) x 3-7 days for cystitis over 2 years; 7-14 days under 2 years or in pyelonephritis Peds 25-50 mg/kg/day [child max 2000 mg] (Mild to moderate infection: 25-50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. Severe infection (the formulary gives bone and joint infection as its example): 75-100 mg/kg/day divided every 6 to 8 hours, maximum 4,000 mg/day.) 3kg -> 75-150 mg/day 4kg -> 100-200 mg/day 5kg -> 125-250 mg/day 6kg -> 150-300 mg/day 7kg -> 175-350 mg/day 8kg -> 200-400 mg/day 9kg -> 225-450 mg/day 10kg -> 250-500 mg/day 11kg -> 275-550 mg/day 12kg -> 300-600 mg/day 13kg -> 325-650 mg/day 14kg -> 350-700 mg/day 15kg -> 375-750 mg/day 16kg -> 400-800 mg/day 17kg -> 425-850 mg/day 18kg -> 450-900 mg/day 19kg -> 475-950 mg/day 20kg -> 500-1000 mg/day 21kg -> 525-1050 mg/day 22kg -> 550-1100 mg/day 23kg -> 575-1150 mg/day 24kg -> 600-1200 mg/day 25kg -> 625-1250 mg/day 26kg -> 650-1300 mg/day 27kg -> 675-1350 mg/day 28kg -> 700-1400 mg/day 29kg -> 725-1450 mg/day 30kg -> 750-1500 mg/day 31kg -> 775-1550 mg/day 32kg -> 800-1600 mg/day 33kg -> 825-1650 mg/day 34kg -> 850-1700 mg/day 35kg -> 875-1750 mg/day 36kg -> 900-1800 mg/day 37kg -> 925-1850 mg/day 38kg -> 950-1900 mg/day 39kg -> 975-1950 mg/day 40kg -> 1000-2000 mg/day 41kg -> 1025-2000 mg/day (upper capped) 42kg -> 1050-2000 mg/day (upper capped) 43kg -> 1075-2000 mg/day (upper capped) 44kg -> 1100-2000 mg/day (upper capped) 45kg -> 1125-2000 mg/day (upper capped) 46kg -> 1150-2000 mg/day (upper capped) 47kg -> 1175-2000 mg/day (upper capped) 48kg -> 1200-2000 mg/day (upper capped) 49kg -> 1225-2000 mg/day (upper capped) 50kg -> 1250-2000 mg/day (upper capped) Choice Alternatives. Cephalexin is the everyday oral choice: cheap, stocked everywhere in Egypt as a suspension, and active against the organisms that cause most childhood urinary infection. Co-amoxiclav is the alternative where a broader cover is wanted; nitrofurantoin treats the bladder only and must not be used when the kidney is involved; ceftriaxone is the injection for the baby or the child too unwell for anything oral. Source Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph) Why A first-generation cephalosporin. The cited disease article says first-generation cephalosporins such as cephalexin cover the usual urinary organisms well, are well tolerated, are widely available and are cheap, with the one drawback that they must be given at least three times a day. The formulary's own indication list for this drug names genitourinary tract infection caused by E. coli, Proteus mirabilis and Klebsiella pneumoniae - the three organisms that cause most childhood urinary infection - so the drug and the indication come from the same monograph as the dose. Caution TABLETS AND SUSPENSION ARE NOT INTERCHANGEABLE MILLIGRAM FOR MILLIGRAM. The formulary states that the tablet and the oral suspension are not bioequivalent and must not be substituted on a mg-per-mg basis. Do not give to a child with a known allergy to cephalexin, to another cephalosporin, or to any component of the preparation. TAKE THE URINE BEFORE THE FIRST DOSE. The specimen must be collected for urinalysis and for culture before any antibiotic is given, or the culture that would have named the organism is lost. Change the antibiotic to whatever the culture says once susceptibilities come back. This choice is empirical - it is what to start, not what to finish on. Egypt AMTHROST 250MG/5ML SUSP. 60ML SIGMA > SABAA 4.50 EGP CEPHOXIN 250MG/5ML DRY SUSP. 60 ML PHARCO B 6.50 EGP CEPHALEXIN 250MG/5ML SUSP. 60ML USP24 ARAB DRUG COMPANY (ADCO) 8.00 EGP CEPHLEX 250 MG/5 ML SUSP. 60ML KAHIRA 10.50 EGP MEDICEFLEXIN 250MG/5ML SUSP. 100ML T3A PHARMA > RIVA PHARMA S.A.E. 14.25 EGP KEFLEX 250MG/5ML PD. FOR ORAL SUSP. 60 ML HIKMA PHARMA 37.00 EGP AMTHROST 125MG/5ML SUSP. 60ML SIGMA > SABAA 4.00 EGP -> ? strength differs, ? different route - not oral liquid CEPHOXIN 125MG/5ML DRY SUSP. 60 ML PHARCO B 6.00 EGP -> ? strength differs, ? different route - not oral liquid 2. AMOXICILLIN + CLAVULANIC ACID [1st line] Adult Simple cystitis 500 mg twice daily; complicated infection or pyelonephritis 875 mg twice daily x 3-7 days for cystitis over 2 years; 10-14 days for pyelonephritis Peds 20-40 mg/kg/day [child max 1500 mg] (THE DOSE DEPENDS ON WHICH SUSPENSION IS IN YOUR HAND, and the milligrams are of the amoxicillin half only. The grid above is the 4:1 suspension (125/31.25 or 250/62.5): 20-40 mg amoxicillin/kg/day in three divided doses, maximum 1,500 mg/day. For the 7:1 suspensions (200/28.5, 400/57) the formulary gives 25-45 mg amoxicillin/kg/day in two divided doses, maximum 1,750 mg/day. The 125 mg/5 mL suspension is the only preparation the formulary allows in a neonate or an infant under 12 weeks.) 3kg -> 60-120 mg/day 4kg -> 80-160 mg/day 5kg -> 100-200 mg/day 6kg -> 120-240 mg/day 7kg -> 140-280 mg/day 8kg -> 160-320 mg/day 9kg -> 180-360 mg/day 10kg -> 200-400 mg/day 11kg -> 220-440 mg/day 12kg -> 240-480 mg/day 13kg -> 260-520 mg/day 14kg -> 280-560 mg/day 15kg -> 300-600 mg/day 16kg -> 320-640 mg/day 17kg -> 340-680 mg/day 18kg -> 360-720 mg/day 19kg -> 380-760 mg/day 20kg -> 400-800 mg/day 21kg -> 420-840 mg/day 22kg -> 440-880 mg/day 23kg -> 460-920 mg/day 24kg -> 480-960 mg/day 25kg -> 500-1000 mg/day 26kg -> 520-1040 mg/day 27kg -> 540-1080 mg/day 28kg -> 560-1120 mg/day 29kg -> 580-1160 mg/day 30kg -> 600-1200 mg/day 31kg -> 620-1240 mg/day 32kg -> 640-1280 mg/day 33kg -> 660-1320 mg/day 34kg -> 680-1360 mg/day 35kg -> 700-1400 mg/day 36kg -> 720-1440 mg/day 37kg -> 740-1480 mg/day 38kg -> 760-1500 mg/day (upper capped) 39kg -> 780-1500 mg/day (upper capped) 40kg -> 800-1500 mg/day (upper capped) 41kg -> 820-1500 mg/day (upper capped) 42kg -> 840-1500 mg/day (upper capped) 43kg -> 860-1500 mg/day (upper capped) 44kg -> 880-1500 mg/day (upper capped) 45kg -> 900-1500 mg/day (upper capped) 46kg -> 920-1500 mg/day (upper capped) 47kg -> 940-1500 mg/day (upper capped) 48kg -> 960-1500 mg/day (upper capped) 49kg -> 980-1500 mg/day (upper capped) 50kg -> 1000-1500 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph) Why The cited disease article names amoxicillin-clavulanate, alongside second and third generation cephalosporins, as a preferred option for an acute uncomplicated urinary infection in a child. The formulary lists urinary tract infection among this drug's oral indications and gives the paediatric milligram-per-kilogram rule quoted below. Caution A CHILD UNDER 40 KG MUST NOT BE GIVEN THE 250 MG FILM-COATED TABLET. The formulary is explicit: that preparation carries a high dose of clavulanic acid for a small child. READ THE RATIO ON THE BOTTLE BEFORE CALCULATING. 4:1 is given three times a day, 7:1 and 14:1 twice a day. Using the wrong frequency for the bottle in hand is the mistake this drug invites. Do not give to a child with a known allergy to penicillins or cephalosporins, or with previous cholestatic jaundice or liver upset on amoxicillin-clavulanate. TAKE THE URINE BEFORE THE FIRST DOSE, and change to a culture-guided antibiotic when susceptibilities return. Egypt AMOCLAWIN 457MG/5ML PD. FOR ORAL SUSP. 60ML SEDICO > SANOFI 22.50 EGP E-MOXCLAV 457MG SUSP. 70 ML EIPICO 24.00 EGP DEXICLAVE 457MG/5ML SUSP. 60 ML RAMEDA > NOVE... 27.50 EGP KLAVOX 457MG/5ML SUSP. 70ML SPIMACO > EIMC 48.00 EGP FONDACLAV 457MG/5ML ORAL SUSP. 75 ML GYPTO PHARMA 78.00 EGP NEW-CLAV 457MG/5ML SUSP. 80ML SIGMA TEC > A... 88.00 EGP MEGAMOX 457MG/5ML SUSP. 70ML AL JAZEERA PH... 100.00 EGP AUGMENTIN 457MG/5ML SUSP. 70 ML MUP > GLAXO S... 137.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral liquid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral liquid 3. CEFTRIAXONE [1st line] Adult 1-2 g once daily by intramuscular or intravenous injection (maximum 2 g daily for a urinary infection) - until the child can keep an oral antibiotic down, then switch Peds 50-75 mg/kg/dose [child max 1000 mg] (Infants, children and adolescents, mild to moderate infection: 50-75 mg/kg as a single daily dose by IM or IV, maximum 1,000 mg a day. Premature and term neonates: 50 mg/kg every 24 hours. The formulary caps most infections other than endocarditis and meningitis at 2 g daily.) 3kg -> 150-225 mg/dose 4kg -> 200-300 mg/dose 5kg -> 250-375 mg/dose 6kg -> 300-450 mg/dose 7kg -> 350-525 mg/dose 8kg -> 400-600 mg/dose 9kg -> 450-675 mg/dose 10kg -> 500-750 mg/dose 11kg -> 550-825 mg/dose 12kg -> 600-900 mg/dose 13kg -> 650-975 mg/dose 14kg -> 700-1000 mg/dose (upper capped) 15kg -> 750-1000 mg/dose (upper capped) 16kg -> 800-1000 mg/dose (upper capped) 17kg -> 850-1000 mg/dose (upper capped) 18kg -> 900-1000 mg/dose (upper capped) 19kg -> 950-1000 mg/dose (upper capped) 20kg -> 1000 mg/dose (capped) 21kg -> 1000 mg/dose (capped) 22kg -> 1000 mg/dose (capped) 23kg -> 1000 mg/dose (capped) 24kg -> 1000 mg/dose (capped) 25kg -> 1000 mg/dose (capped) 26kg -> 1000 mg/dose (capped) 27kg -> 1000 mg/dose (capped) 28kg -> 1000 mg/dose (capped) 29kg -> 1000 mg/dose (capped) 30kg -> 1000 mg/dose (capped) 31kg -> 1000 mg/dose (capped) 32kg -> 1000 mg/dose (capped) 33kg -> 1000 mg/dose (capped) 34kg -> 1000 mg/dose (capped) 35kg -> 1000 mg/dose (capped) 36kg -> 1000 mg/dose (capped) 37kg -> 1000 mg/dose (capped) 38kg -> 1000 mg/dose (capped) 39kg -> 1000 mg/dose (capped) 40kg -> 1000 mg/dose (capped) 41kg -> 1000 mg/dose (capped) 42kg -> 1000 mg/dose (capped) 43kg -> 1000 mg/dose (capped) 44kg -> 1000 mg/dose (capped) 45kg -> 1000 mg/dose (capped) 46kg -> 1000 mg/dose (capped) 47kg -> 1000 mg/dose (capped) 48kg -> 1000 mg/dose (capped) 49kg -> 1000 mg/dose (capped) 50kg -> 1000 mg/dose (capped) AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) Why The injection for the child who cannot be treated by mouth. The cited disease article says the parenteral route is advised for any infant of 2 months or under, and for any child who looks toxic, who has bacteraemia or sepsis, whose circulation is unstable, who is immunocompromised, who cannot keep an oral medicine down, or who has not responded to one. The formulary names complicated urinary tract infection including pyelonephritis among this drug's indications and gives the paediatric rule below. Give it as part of getting the child to hospital, not instead of it. Caution UNDER 3 MONTHS, REFER - DO NOT SIMPLY TREAT. NICE NG224 sends a baby under 3 months with a suspected urinary infection to paediatric specialist care with an urgent urine microscopy and culture. An injection given on the way is not a substitute for that referral. NEVER WITH AN INTRAVENOUS CALCIUM-CONTAINING FLUID IN A NEONATE (28 days or under). The formulary makes this an absolute contraindication. NOT IN A JAUNDICED NEWBORN, especially a premature one: the formulary states that ceftriaxone displaces bilirubin from albumin. Do not give to a child with a known allergy to ceftriaxone or another cephalosporin. Oral antibiotics work as well as intravenous ones in a child who is not toxic, including in acute pyelonephritis. Switch to the mouth as soon as the child improves and can keep a medicine down. Egypt TRIXOMASH 500MG VIAL FOR I.V. INJ. RAMEDA > MASH PREMIERE 16.50 EGP WINTRIAXONE 500 MG PD. FOR I.V INJ. SANOFI 21.75 EGP CEFAXONE 500MG I.V. VIAL PHARCO B 25.25 EGP TRIAXONE 500MG VIAL FOR I.M. INJ. TABUK PHARMACEUTICAL MANUFACTURING COM... 36.00 EGP TRIAMERICAN 500 MG I.M. VIAL RAMEDA > PAXAL 46.00 EGP EPICEPHIN 500 MG I.V. VIAL EIPICO 47.00 EGP CEFAXOTREZ 500 MG I.M. VIAL RAMEDA > BOST... 63.00 EGP CEFAXOTREZ 500 MG I.V. VIAL RAMEDA > BOST... 63.00 EGP 4. NITROFURANTOIN [2nd line] Adult 50-100 mg four times daily x 7 days, or at least 3 days after the urine is sterile Peds 5-7 mg/kg/day (Children of 1 month and over: 5-7 mg/kg/day in four divided doses for 7 days, or for at least 3 days after the urine becomes sterile. For long-term suppression the formulary gives 1 mg/kg/day as a single dose or in two divided doses. For prevention of recurrence: 1-2 mg/kg/day, single bedtime dose or divided twice daily, maximum 100 mg/day.) 3kg -> 15-21 mg/day 4kg -> 20-28 mg/day 5kg -> 25-35 mg/day 6kg -> 30-42 mg/day 7kg -> 35-49 mg/day 8kg -> 40-56 mg/day 9kg -> 45-63 mg/day 10kg -> 50-70 mg/day 11kg -> 55-77 mg/day 12kg -> 60-84 mg/day 13kg -> 65-91 mg/day 14kg -> 70-98 mg/day 15kg -> 75-105 mg/day 16kg -> 80-112 mg/day 17kg -> 85-119 mg/day 18kg -> 90-126 mg/day 19kg -> 95-133 mg/day 20kg -> 100-140 mg/day 21kg -> 105-147 mg/day 22kg -> 110-154 mg/day 23kg -> 115-161 mg/day 24kg -> 120-168 mg/day 25kg -> 125-175 mg/day 26kg -> 130-182 mg/day 27kg -> 135-189 mg/day 28kg -> 140-196 mg/day 29kg -> 145-203 mg/day 30kg -> 150-210 mg/day 31kg -> 155-217 mg/day 32kg -> 160-224 mg/day 33kg -> 165-231 mg/day 34kg -> 170-238 mg/day 35kg -> 175-245 mg/day 36kg -> 180-252 mg/day 37kg -> 185-259 mg/day 38kg -> 190-266 mg/day 39kg -> 195-273 mg/day 40kg -> 200-280 mg/day 41kg -> 205-287 mg/day 42kg -> 210-294 mg/day 43kg -> 215-301 mg/day 44kg -> 220-308 mg/day 45kg -> 225-315 mg/day 46kg -> 230-322 mg/day 47kg -> 235-329 mg/day 48kg -> 240-336 mg/day 49kg -> 245-343 mg/day 50kg -> 250-350 mg/day Source Egyptian National Drug Formulary - Antimicrobial 2023 (nitrofurantoin monograph) Why A urinary antiseptic that concentrates in the bladder urine. The formulary names acute uncomplicated cystitis as its indication and gives a paediatric rule from one month of age. It is kept at second line here for the reason the disease article gives: it does not reach the kidney, so it is the wrong drug the moment the infection is above the bladder - and in a young child that is hard to be sure of. Caution NOT FOR PYELONEPHRITIS, AND NOT WHEN YOU CANNOT EXCLUDE IT. The cited disease article states that nitrofurantoin does not penetrate the kidney tissue or the bloodstream well and is unsuitable for pyelonephritis, particularly in younger children. CONTRAINDICATED UNDER 1 MONTH OF AGE. The formulary bars it in a neonate because an immature red-cell enzyme system can lead to haemolytic anaemia. Contraindicated in anuria, oliguria or significant renal impairment (creatinine clearance under 60 mL/min), and after previous cholestatic jaundice or liver dysfunction on nitrofurantoin. The formulary notes rising resistance to this drug in some areas. Culture matters more here than with the cephalosporins. Give with food. The urine turns brown - warn the parent, it is harmless. Egypt MACROFURAN 50 MG 30 CAPS. KAHIRA 51.00 EGP (1.70/unit) -> ? different route - not oral liquid MEPAFURAN 50 MG 20 CAPS. MEPACO 34.00 EGP (1.70/unit) -> ? different route - not oral liquid MAIN TREATMENT 5. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Urinary tract infection in under 16s: diagnosis and management - NICE Guideline NG224 (NCBI Bookshelf NBK588844) - https://www.ncbi.nlm.nih.gov/books/NBK588844/ Why The antibiotic choices for a urinary infection are the same drugs a child would get anywhere and are dosed on the uti-uncomplicated card. What is specific to children is who must be referred rather than treated, how the urine has to be collected before it means anything, and which child needs a scan afterwards. No antibiotic row is printed here because neither cached article states a milligram-per-kilogram amount, and a dose carried across from an adult card is a dose nobody checked. Caution UNDER 3 MONTHS, DO NOT TREAT - REFER - a baby under 3 months in whom a UTI is suspected (NG224 table 1; recommendation 1.1.2) goes to paediatric specialist care, with a urine sample sent for microscopy and culture urgently. NICE then hands the baby to the fever pathway rather than to a prescription. A NEWBORN GOES DOWN THE NEONATAL ROUTE, NOT THE URINE ROUTE - within the first 28 days, a bacterial infection suspected or confirmed is one NICE sends elsewhere: assess and manage it by the NICE guideline on neonatal infection and the antibiotics used to prevent and to treat it. PARENTERAL THERAPY, NOT ORAL, FOR THE VERY YOUNG OR THE VERY UNWELL - antibiotics are advised by the parenteral route in any infant of 2 months or under, and in any child who looks toxic, who has bacteraemia or sepsis, whose circulation is unstable, who is immunocompromised, who cannot keep an oral medicine down, or who has failed to respond to one. GET THE URINE BEFORE THE ANTIBIOTIC - take the urine sample from the child or young person before any antibiotic is given. The specimen is collected for urinalysis and for culture both, and it is collected first. A BAG SPECIMEN CANNOT DIAGNOSE AN INFECTION - urine caught in a bag may be put through urinalysis, but it must NOT be cultured: bacteria living on the skin around the genitals, and nowhere in the urinary tract, can contaminate it. Cultures from a perineal bag throw up false positives at a rate that cannot be accepted, and count only when the result comes back negative. NICE adds that cotton wool balls, gauze and sanitary towels must NOT be used to collect urine from a baby or a child. THE DIPSTICK ONLY WORKS AS A PAIR - a test strip is validated for ruling infection in or out only when nitrite, which marks some gram-negative organisms, and leucocyte esterase (LE), which marks white cells, are read together. Blood on the stick, or protein, is not a dependable sign of UTI. HOW NICE WANTS THE DIPSTICK ACTED ON, 3 MONTHS TO 3 YEARS - where leucocyte esterase and nitrite are both negative, do NOT give an antibiotic, and do NOT send anything for microscopy and culture - unless recommendation 1.1.21 supplies at least 1 reason to send it. Where either is positive, or both are, the sample goes for culture and antibiotics are given. HOW LONG TO TREAT, BY AGE AND BY LEVEL - for infants, for toddlers under 24 months, and for older children with pyelonephritis, the advised course runs 7 to 14 days. An older child with cystitis may need only 3 to 7 days. Acute pyelonephritis can be treated orally for 10 to 14 days, or intravenously for 2 to 4 days and then by mouth. REASSESS AT 48 HOURS IF NOTHING IS IMPROVING - in UTI, acute pyelonephritis included, oral antibiotics work as well as intravenous ones so long as the child is not toxic. NICE counts failing to respond to a suitable antibiotic inside 48 hours as one of the marks of an atypical infection. WHAT COUNTS AS ATYPICAL, WHICH IS WHAT DRIVES THE SCAN - NICE's own box holds: a child who is seriously ill; a poor stream; a mass in the abdomen or the bladder; a creatinine that has risen; septicaemia; no response to a suitable antibiotic inside 48 hours; and an organism that is not E. coli. AND WHAT COUNTS AS RECURRENT - two or more episodes involving the upper tract (acute pyelonephritis); or 1 upper-tract episode together with 1 or more lower-tract episodes (cystitis); or three or more lower-tract episodes on their own. WHO GETS AN ULTRASOUND, AND WHEN - a baby or child with an atypical UTI (see box 1) has the urinary tract scanned while the infection is still running. A baby under 6 months whose first UTI responds to treatment is scanned inside 6 weeks of it. Over 6 months, do NOT routinely scan a first UTI that responds, unless it was atypical. And after a lower- tract infection the scan (inside 6 weeks) is reserved for those under 6 months, or those whose infections keep coming back. DO NOT ORDER A MICTURATING CYSTOGRAM AFTER ONE INFECTION - a VCUG as a matter of routine is NOT advised once a child has had a first UTI. Consider it ONLY where the ultrasound of kidneys and bladder has shown a hydroureter, hydronephrosis, scarring or something else suggestive, or where a febrile UTI has come back. NO PROPHYLACTIC ANTIBIOTIC AFTER A FIRST INFECTION - prophylaxis must NOT be given routinely to a baby or child after a first UTI, and must NOT be given at all for bacteriuria that is causing no symptoms. CONSTIPATION IS THE COMMONEST FIXABLE CAUSE OF REPEAT INFECTIONS - screening for bowel and bladder dysfunction and treating it prevents UTI, is safe, works, and is thought of far too little. Asking about constipation, about wetting in the daytime, and about holding on will find the children who have it. The measures listed are voiding to a timetable every 3 to 4 hours, drinking enough, and treating the constipation itself. As for cranberry juice, the evidence to recommend it for preventing UTI is not there. TELL THE FAMILY WHAT TO DO AT THE NEXT FEVER - where a child's UTIs keep returning, the parents are told to bring them to be seen promptly with any future febrile illness, so that it is caught early and treated in time - inside 48 hours - and the kidney is spared damage. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. 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