August Week 4: Urinary Tract Infections

American Academy of Pediatrics. Practice Parameter: The Diagnosis, Treatment and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children. Pediatrics 1999;103:843-852.

Alper B et al. Urinary Tract Infection in Children. American Family Physician. Dec 2005:72(12).

Case 1
A distraught mother has brought her 10-month-old, circumcised male to your clinic. She says that the child had been very fussy for the past 2 days and had vomited once earlier today but had not previously. She took a rectal temperature last night that was 100.8 and started dosing Tylenol. She denies a history of cough, breathing difficulty, runny nose or diarrhea. He has had no sick contacts. He is febrile now at 101.5. The examination appears benign with no localizing signs of infection. During the exam, the infant appears non-toxic and is fussy but interactive. You suspect a diagnosis of UTI.

  • How should you proceed with making a diagnosis?
  • Should you initiate antibiotics? What are the most likely organisms? Which antibiotic should be used?
  • How would your management change if the patient appeared more ill on presentation?

You initiate treatment and the child’s condition improves in 48 hours. The mother comes back in with the baby for follow up after two days.

  • What do you tell the mother about further evaluation and treatment?

Case 2
A 2-year-old female comes to your clinic with her parents who report a three day history of crying with urination and increased frequency. They report that she has not had fever, vomiting or diarrhea. She has had no change in oral intake or in her level of activity.

  • What other specific questions would you ask?
  • What types of evaluation should be performed?
  • How would you advise these parents?

Case 3
A 4-year-old female with a history of recurrent UTI comes in for follow up. Her mother asks what her diagnosis of Grade-II VUR means and what comes next.

  • What do you tell her?