Pediatric UTI; Practice guideline from AAP

Pediatrics PGY1 PGY2 PGY3 PGY4

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

Link to AAP

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)

Link to Article

4. Treatment should be for 7-14 days:

PO antibiotic:


Antimicrobial Agent Dosage
Amoxicillin-clavulanate 20–40 mg/kg per d in 3 doses
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
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

Link to article




Leave a Reply