UTI Treatment

Significant bacteriuria:

> 105 colonies/ml of single bacteria in mid void stream

>104 colonies/ml of single bacteria in urethral catheterization

Any number in suprapubic aspiration.

Asymptotic bacteriuria:

Significant bacteriuria with no sign or symptom

Does not treatment

UTI:

 Clinical features + Significant bacteriuria

Complicated UTI:

1. Age < 3 months
2. Fever > 39°C / 102.2°F
3. Vomiting & Dehydration →refusal to feed → sick look & lethargy 
4. Renal angle tenderness
5. Elevated S. Creatinine
6. Non Escherichia coli UTI

Recurrent UTI:

2nd episode of UTI any time after 1st episode.

Treatment:

 Complicated 1st uti:

1. Admit & iv fluids + antibiotics for 2 days
2. If Symptomatic improvement, oral antibiotics for 10-14 days
3. Urine RM @ end of Rx. No need for urine culture.

Uncomplicated 1st UTI

1. Oral antibiotics for 2 days
2. If good response, continue the same for 7-10 days
3. Urine RM @ end of Rx. No need for urine culture.

Recurrent UTI:

Start antibiotics & refer to Nephrologist for further investigation.

Further investigations:

Age	Must	If
1st UTI
< 1yr	USG KUB, DMSA, MCU
1-5 yrs	USG KUB, DMSA	If DMSA abnormal MCU
> 5 yrs	USG KUB	if USG abnormal DMSA & MCU
Recurrent UTI
Any	USG KUB, DMSA, MCU + Pediatric Nephrologist Opinion

Antibiotics:

I.V
3rd gen cephalosporins	safe & effective	Ceftriaxone 75-100 mg/kg/day OD / BD Cefotaxime 100mg/kg/day BD / TDS
Aminoglycosides	Amikacin 10-15mg/kg/day OD / BD  Gentamicin 5-6mg/kg/day OD / BD
Oral
Cefixime - 10mg/kg/day BD	Effective broad spectrum empiric Rx
Amoxicillin/ cephalexin/ cefdroxil - 30-50mg/kg/day BD or TDS	Can be used in uncomplicated UTI
Prophylaxis
Cephalosporins antibiotics	safe in infancy	Cephalexin 10mg/kg/day BD Cefdroxil 3-5mg/kg/day BD
Septran Nitrofurantoin	not safe if infancy & G6PD	Trimethoprim 1-2 mg/kg/ day Nitrofurantoin 1-2 mg/kg/day