URINARY TRACT INFECTION Flashcards
History & Physical
Neonates:
Indistinguishable from sepsis -
Ask about, fever, jaudice, poor feeding, vomit, irritable, lethargic
Infants / Young Children:
Abdominal pain, vomit, decreased appetite.
Children / Adolescents:
Dysuria, frequency, urgency, hesitancy
Ask about fevers, vomit, flank pain, previous UTI, previous GU medical history
Ask about chemical expsosure, STI risk factors
DDx: Dysuria
STI Urethritis
Irritant Urethritis (soaps, clothing, poor hygiene)
Vaginitis
Meatitis
Balanitis (boys)
Who to test
3-24 mos: all girls, uncircumcised boys if > 1 risk factor, circumcised boys > 2 risk factors
For children 2-23 mos can use UTICalc to determine who to test by pre-test probability
> 24 mos if symptomatic
Investigations
Urine Microscopy and Dipstick
Infants / Diapers:
Transurethral Catheter
Bladder tapping to get them to pee and clean catch mid stream
Toilet Trained:
Clean Catch
Gold Standard is growth of a single urinary pathogen
Ultrasound KUB
What children need imaging
<2 with a fever
Recurrent
Complicated
Get Renal Bladder Ultrasound
If abnormal go to voiding cystourethrogram
Management & Disposition: Neonatal UTI
Septic Workup
CIRCULATION:
IF dehydrated
20 ml / kg IV bolus NS over 15-20 min
Repeat until perfusion improves and urine output is adequate
THEN
Maintenance 4 cc / hr for 1st 10 kg, 2 cc / hr for 10-20 kg, 1 cc / hr per kg for every kg > 20 kg
D10 Water on day 1
D5 1/2 NS day 2 - 7
Antibiotics:
Ampicillin 100-200 mg / kg / day IV div q8h (max 3 g / dose, 12 g / day)
PLUS
Cefotaxime 50 mg / kg / dose
Admission
Management & Disposition: Infants 1 month - 2 years
Ceftriaxone 50 mg / kg / dose IV q 24 hr (max 2 g / day)
THEN
7-14 days of:
TMP SMX 6 to 12 mg TMP/kg/day in divided doses every 12 hours; maximum dose: 160 mg/dose
Cephalexin 25-100 mg / kg / day PO div qid
Amoxicillin 40-50 mg / kg / day IV div q 8 h
Amoxicillin-Clavulanate 80-90 mg / kg / day of amoxicillin div q 8-12 h (max 875 mg/dose)
If resistance to the above:
Cefixime 8 mg / kg / day div bid
OR
Cefdinir 7 mg / kg / dose bid (may not be available)
If well appearing discharge with PCP follow up
If ill appearing, dehydrated, vomiting:
20 ml / kg IV bolus NS over 15-20 min
Repeat until perfusion improves and urine output is adequate
THEN
Maintenance 4 cc / hr for 1st 10 kg, 2 cc / hr for 10-20 kg, 1 cc / hr per kg for every kg > 20 kg
D5 NS + 20 mEq/L KCL if isotonic dehydration
D5 1/2 NS + 20 mEq KCL if hypernatremic dehydration
Ondansetron:
2 mg < 15 kg
4 mg > 15 kg
8 mg > 30 kg
Admission
Management: Children over 2 yr
Ceftriaxone 50 mg / kg / dose IV q 24 hr (max 2 g / day)
THEN
7-14 days of:
TMP SMX 6 to 12 mg TMP/kg/day in divided doses every 12 hours; maximum dose: 160 mg/dose
Cephalexin 25-100 mg / kg / day PO div qid
Amoxicillin 40-50 mg / kg / day IV div q 8 h
Amoxicillin-Clavulanate 80-90 mg / kg / day of amoxicillin div q 8-12 h (max 875 mg/dose)
If resistance to the above:
Cefixime 8 mg / kg / day div bid
Management: Adolescent females older than 13 yrs
As adult UTI
