Urinary Tract Infection — Imaging, Prophylaxis and Referral Recommendations — Clinical Pathway: All Settings

Urinary Tract Infection (UTI) Clinical Pathway — All Settings

Imaging, Prophylaxis and Referral Recommendations

Renal Bladder Ultrasound (RBUS)
  • Obtain RBUS:
    • All children < 24 mos after their first febrile UTI
    • Circumcised males ≥ 24 mos with febrile UTI
  • Consider RBUS in older children after first febrile UTI
  • RBUS can be obtained after the child has recovered from the acute infection (4-6 weeks)
  • Obtain RBUS during acute illness for children with:
    • Concern for sepsis
    • Abdominal or pelvic mass
    • Inadequate response after 48 hours of therapy
    • Consider for any hospitalized child
    • Adolescent males
Refer to Urology
  • Second febrile UTI
  • Abnormal RBUS
  • Significant illness (i.e., urosepsis) with febrile UTI
  • UTI in children with other medical conditions that influence bladder function
    • E.g., spina bifida, CP, encephalopathy, mitochondrial diseases
Children 2-24 Months, Abnormal RBUS or Second Febrile UTI
  • Schedule VCUG
  • Schedule an appointment with Urology within 1-2 weeks
  • Educate family about low threshold for obtaining urine culture with future febrile illnesses
  • Start prophylaxis pending Urology appointment

Prophylaxis

1st Choice
  • Trimethoprim-sulfamethoxazole, oral
  • 2 mg/kg/dose every 24 hours
2nd Choice
  • Nitrofurantoin, oral
  • 1 mg/kg/dose every 24 hours; maximum: 100 mg/day
Note: If UTI is caused by an organism resistant to trimethoprim-sulfamethoxazole, trimethoprim-sulfamethoxazole may still be used for prophylaxis.