Pathway for the Evaluation and Treatment of Children with Febrile UTI

Antibiotic Recommendations

Empiric Antibiotic Treatment Based on Urinalysis Results

Ill-appearing children should be treated immediately, obtain urine for culture prior to treatment when possible.

Dipstick Positive nitrite OR LE 2+
Standard UA >5 WBC / hpf AND bacteria

Other Pathways

IV vs PO

Consider initial IV treatment if:

  • Infants < 6 months of age
  • Moderate / Severe Dehydration
  • Vomiting, inability to tolerate oral fluids, antibiotics
  • Concern for follow-up

Other Testing

  • Routine Blood culture, CBC, CRP, BMP are NOT recommended

Recommended Antibiotics*


  • 1st choice
    • Cephalexin
  • Type 1 Penicillin Allergy (defined as urticaria or anaphylaxis) or cephalosporin allergy
    • Trimethoprim-sulfamethoxazole
  • Sulfa allergy
    • Ciprofloxacin

Length of Treatment

≤ 6 months 10 days
>6 months 7 days


  • Ampicillin + Gentamicin
  • Gentamicin levels are not necessary unless treatment continues > 48 hours
  • PCN Allergy, use Gentamicin alone


Use Febrile Urinary Tract Infection Order Set or CHOP Formulary

*If previous UTI, review previous organism, sensitivities
If patient is on prophylaxis, do not use the same antibiotic for treatment

Refer to Inpatient Febrile Young Infant pathway for antibiotic choices for children < 57 days