Recently, AAP published a practice guideline on “Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months” in Sept, 2011. There are a lot of useful information about UTI, diagnosis and treatment. You can see the article here but I highlighted some of data:
1. If you apply urine bag and your test(culture) is negative you can count on it but if it is positive due to high false positive you should not interpret the result.
2. Girls with :
A. no identifiable source of infection
B. White Race
C. Age < 12 months
D. Onset of symptoms(<2 days)
E. Fever =>39
= 1% probability of UTI for 1 risk factor
= 2% probability of UTI for 2 risk factors
3. Sensitivity and Specificity of Components of Urinalysis
| Test | Sensitivity (Range), % | Specificity (Range), % |
|---|---|---|
| Leukocyte esterase test | 83 (67–94) | 78 (64–92) |
| Nitrite test | 53 (15–82) | 98 (90–100) |
| Leukocyte esterase or nitrite test positive | 93 (90–100) | 72 (58–91) |
| Microscopy, WBCs | 73 (32–100) | 81 (45–98) |
| Microscopy, bacteria | 81 (16–99) | 83 (11–100) |
| Leukocyte esterase test, nitrite test, or microscopy positive | 99.8 (99–100) | 70 (60–92) |
4. Treatment should be for 7-14 days:
PO antibiotic:
| Antimicrobial Agent | Dosage |
|---|---|
| Amoxicillin-clavulanate | 20–40 mg/kg per d in 3 doses |
| Sulfonamide | |
| Trimethoprim-sulfamethoxazole | 6–12 mg/kg trimethoprim and 30-60 mg/kg sulfamethoxazole per d in 2 doses |
| Sulfisoxazole | 120–150 mg/kg per d in 4 doses |
| Cephalosporin | |
| Cefixime | 8 mg/kg per d in 1 dose |
| Cefpodoxime | 10 mg/kg per d in 2 doses |
| Cefprozil | 30 mg/kg per d in 2 doses |
| Cefuroxime axetil | 20–30 mg/kg per d in 2 doses |
| Cephalexin | 50–100 mg/kg per d in 4 doses |
IV Antibiotic:
| Antimicrobial Agent | Dosage |
|---|---|
| Ceftriaxone | 75 mg/kg, every 24 h |
| Cefotaxime | 150 mg/kg per d, divided every 6–8 h |
| Ceftazidime | 100–150 mg/kg per d, divided every 8 h |
| Gentamicin | 7.5 mg/kg per d, divided every 8 h |
| Tobramycin | 5 mg/kg per d, divided every 8 h |
| Piperacillin | 300 mg/kg per d, divided every 6–8 h |
all these are from New practice guideline by American Academy of Pediatrics Journal