Urinary Tract Infection (UTI) in Children
UTIs in children are critical to identify early to prevent renal scarring, hypertension, and chronic kidney disease. Escherichia coli is the most common causative organism.
1. Diagnosis & Investigation
- Gold Standard: Urine culture (suprapubic aspiration, catheterization, or clean-catch).
- Urinalysis: Nitrite (high specificity) and Leukocyte Esterase (high sensitivity) are key indicators.
- Imaging: Renal and bladder ultrasound (RBUS) is indicated for all children after their first febrile UTI. Voiding cystourethrogram (VCUG) is reserved for abnormal ultrasound findings or recurrent UTIs.
2. Management Principles
| Clinical Status | Management |
|---|---|
| Stable/Febrile | Oral antibiotics (e.g., Cefixime, Cefdinir) or IV if toxic. |
| Neonates/Ill-appearing | Parenteral antibiotics (e.g., Ampicillin + Gentamicin or Ceftriaxone). |
3. Follow-up
Prophylactic antibiotics are no longer recommended for all children with low-grade Vesicoureteral Reflux (VUR); management is individualized based on the grade of reflux and risk of recurrence.
NEET PG Hint: Remember the top-down vs. bottom-up approach: Ultrasound is the first-line “top-down” approach to evaluate structural anatomy. Always check for free medical questions to test your clinical reasoning at mymedschool.org.