Practice Guidelines

Diagnosis and management of urinary tract infection in children: summary of NICE guidance

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39286.700891.AD (Published 23 August 2007) Cite this as: BMJ 2007;335:395
  1. Rintaro Mori, research fellow1,
  2. Monica Lakhanpaul, clinical co-director for guidelines, and senior lecturer in child health2,
  3. Kate Verrier-Jones, reader in child health, Cardiff University, and honorary consultant paediatric nephrologist, University Hospital of Wales3
  1. 1National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians and Gynaecologists, London NW1 4RG
  2. 2National Collaborating Centre for Women's and Children's Health, Royal College of Obstetricians and Gynaecologists, and University of Leicester, Leicester
  3. 3Cardiff and Vale NHS Trust, Cardiff CF14 4XN
  1. Correspondence to: M Lakhanpaul mlakhanpaul{at}ncc-wch.org.uk

    Why read this summary?

    Although urinary tract infection affects at least 3.6% of boys and 11% of girls, establishing the diagnosis is difficult in early childhood owing to the lack of specific urinary symptoms, difficulty in urine collection, and contamination of samples. Most children have a single episode and recover promptly. Current imaging, prophylaxis, and prolonged follow-up strategies place a heavy burden on patients, families, and NHS resources and carry risks without evidence of benefit. This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on how to provide consistent clinically and cost effective practice for the diagnosis, treatment, and further management of urinary tract infection in childhood.1

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*).

    Assessment and diagnosis

    • • Consider a diagnosis of urinary tract infection in all infants and children with:

    • (a) unexplained fever of 38°C or higher after 24 hours at the latest

    • (b) symptoms and signs suggestive of urinary tract infection, including:

    • - fever2

    • - non-specific symptoms, such as lethargy, irritability, malaise, failure to thrive, vomiting, poor feeding, abdominal pain, jaundice (in infants)

    • - specific symptoms, such as frequency, dysuria, loin tenderness, dysfunctional voiding, changes to continence, haematuria, and offensive or cloudy urine.

    • • Collect a urine sample:

    • (a) do this preferably by clean catch, but if this is not possible, use a urine collection pad but not cotton wool balls, gauze, or sanitary towels.

    • (b) if non-invasive techniques are not possible, use a catheter sample or suprapubic aspirate with ultrasound guidance.

    • • Test the urine sample: for infants younger than 3 months, refer to a paediatric specialist, who should send …

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