UTI in children may be a red flag that indicates the presence of an underlying urological problem or functional bowel bladder dysfunction. Repeated attacks of UTI can cause renal damage with resultant scarring of the kidneys. Severe scarring could lead to the development of hypertension and sometimes to renal failure in later childhood or in early adult life.

The diagnosis of UTI requires three criteria to be fulfilled – Symptoms compatible with UTI, pyuria in routine urinalysis and a urine culture growing a single organism in significant numbers .Though a urine routine showing  pyuria in a febrile child provides a provisional diagnosis , a urine  culture prior to initiating antibiotics is necessary for confirming the diagnosis.

Moderate to high fever without a focus, f ever with vomiting, abdominal or back pain or frequency and burning micturition are some of the common symptoms of UTI

The presence of more than 5 leucocytes/hpf in a centrifuged sample of urine is indicative of significant pyuria. In severe cases urine maybe hazy and have WBC casts

The growth of a single species of bacteria in urine culture equal to or greater than 1,00,000 colony forming units /ml on a midstream sample of urine is considered as confirmatory evidence

The choice and route of administration of antibiotics depends on the age of the child and the presence of systemic symptoms.  Children less than 3 months of age with UTI or those who are very sick need hospitalization and intravenous antibiotics. Children above 3 months of age who are not very sick can be treated with oral antibiotics on outpatient basis. The parenteral antibiotics used are either third generation cephalosporins or aminoglycosides. Monotherapy is  recommended except in the new-born period. The oral antibiotics used are cefixime, co-amoxiclav, ciprofloxacin or cephalexin depending on the regional resistance patterns of bacteria.

Antibiotics are given for 7 to 10 days

USG should be done in all patients with UTI as soon as possible after the diagnosis of UTI.

MCU should be done after the completion of treatment of UTI in the following cases- in all children less than 1 year of age with UTI, in older children with recurrent UTI and in children who have abnormalities detected on USG.

DMSA is a radionuclide scan which can detect cortical scarring. It identifies those children who are at risk for future problems. It should be done 3 to 4 months after the treatment of the acute attack

 Children less than 1 year who are awaiting further investigations, children with recurrent febrile UTI and those with diagnosed vesicoureteral reflux require urinary prophylaxis. 

Cotrimoxazole or nitrofurantoin are the preferred drugs in children above 3 months of age. Cephalexin or amoxycillin can be used for prophylaxis in neonates and infants less than 3 months of age

1. Child with recurrent UTI
2. Child with underlying VUR
3. Child with bowel,bladder disturbance
4. Child with increased serum creatinine
5. Child with scars on DMSA scan