Urinary Tract Infection (UTI)

Clinical definition:

Uncomplicated UTI is an infection limited to the lower urinary tract with no associated urological anomalies. It is seen most in girls older than 2 years of age. Complicated UTI is an infection involving the renal parenchyma (acute pyelonephritis) or which is associated with underlying congenital anomalies of the kidneys and urinary tract. Differentiating uncomplicated from complicated UTI is often not feasible in neonates and infants and they should be treated as for complicated UTI. UTI may result in significant short-term morbidity, including septic shock and acute renal failure, especially in infants. Permanent renal damage may occur in children who have recurrent episodes of pyelonephritis. Common aetiologies include Enterobacterales (E. coli, Klebsiella species, Proteus species, Enterobacter species) and Enterococcus species. For UTI in pregnant adolescents, refer to adult guidelines.

 

Neonate

(Treat all UTIs in neonates as complicated UTIs)

Preferred antibiotic choice
Drug Formulation Dosage Duration
Cefotaxime (IV) Powder for injection: 250 mg per vial (as sodium salt) o   First week of life (7 days or less): 50 mg/kg/dose 12 hourly

o   8 – 20 days: 50 mg/kg/dose 8 hourly

o   21 days & older: 50 mg/kg/dose 6 hourly

10 – 14 daysA

Infant, Child & Adolescent

Preferred antibiotic choice
Drug Formulation Dosage Duration
If oral route suitable:

Amoxicillin + clavulanic acid (PO)

OR

Nitrofurantoin (PO)

Amoxicillin + clavulanic acid- Oral liquid: 125 mg amoxicillin + 31.25 mg clavulanic acid/5 mL; 250 mg amoxicillin + 62.5 mg clavulanic acid/5 mL; Tablet: 500 mg (as trihydrate) + 125 mg (as potassium salt). 10-15 mg/kg of amoxicillin component/dose 8 hourly, maximum dose 250 mg of amoxicillin component 8 hourly

If the formulation containing 875 mg amoxicillin + 125 mg clavulanic acid is available, this may be prescribed twice a day for children weighing 25 kg or more

Uncomplicated UTI:

5 –7 days

Complicated UTI:

10 days

Nitrofurantoin- Oral liquid: 25 mg/5 mL. Tablet: 100 mg. 1 – 2 mg/kg/dose 6 hourly, maximum dose 100 mg 6 hourly
If oral route not suitable or for complicated UTI, treat with:

Ceftriaxone (IV) OR

Gentamicin (IV)

Ceftriaxone- Powder for injection: 250 mg; 1 g (as sodium salt) in vial.  

50 mg/kg/dose once daily, maximum dose 1 g

Gentamicin- Injection: 10 mg; 40 mg (as sulfate)/ mL in 2- mL vial.  

5 – 7.5 mg/kg/dose once daily, maximum dose 360 mg

Alternative antibiotic choice, guided by culture results, or in case of poor response to preferred antibiotic choice
Drug Formulation Dosage Duration
Ciprofloxacin (PO for uncomplicated, IV for complicated UTI) Oral liquid: 250 mg/5 mL (anhydrous) ; Tablet: 250 mg (as hydrochloride); Solution for IV infusion: 2 mg/ mL (as hyclate). Oral therapy:

10-15 mg/kg/dose 12 hourly, maximum dose 500 mg 12 hourly

IV therapy:

10 mg/kg/dose 8-12 hourly, maximum dose 400 mg 8-12 hourly

Uncomplicated UTI:

5 – 7 days

Complicated UTI: 7 days

 

 

A. After 5-7 days, or sooner if there is a good clinical response to treatment, consider switching to an oral antibiotic to complete a total treatment duration of 10 days. Oral antibiotic selection should be guided by urine culture and antibiotic susceptibility results or use amoxicillin/clavulanic acid if urine culture is not available.

 

Principles of Stewardship:

  • Avoid the use of fluoroquinolones whenever possible.
  • Do not treat asymptomatic patients outside of pregnancy.
  • The choice of route of therapy should be determined by the ability to tolerate oral therapy and/or the presence of significant systemic illness.

Notes:

  • Children younger than 5 years of age with a confirmed UTI and children with recurrent or persistent UTIs should have an ultrasound scan of the kidneys, ureter and bladder to screen for abnormalities of the urinary tract and/or be referred to a specialist for further investigations.