UTI CPG

1. # 32 Misamis St., Bago Bantay, Quezon City 1105
Tel. Nos.926-6758 / 926-6759 Fax. No. (632) 926-238-L
An Official Publication of the
Philippine Pediatric Society, lnc.
Clinical Practice Guideline
In The Approach And
Treatment Of Urinary Tract
Infection In Children
In The Philippine Setting

2. PHILIPPTNE Pf,DIATRIC S@IETY, INC.
BOARD OT TRUSTSES
200:!2004
OTTICEf,S
IA.tuWt
JOEL A ELISES. [1D,
ESTRILT, P 4LLA& III.D,
!.ICTOR 6, DolC.rO& ttl.D.
aLEX^NDEI (} TUAZON, i,t_D.
JOCELYN J. Y^ltEAO-ftlrNCO. t1D.
MAY E. MOI{TEIIANO, nl(D.
CARI,IEI.o A AIFTLE& M.D,
EE DEL MIJIID('. ITID-
DISCLAIMER
Tt tE@.&IbB @6ir.d in 6. doorr[l ol UE hilipiE Pdiltio
Sodar, h-, Co@iE o! Cri@l PtGt! Gui&liG e i r Ld to GUIDE
9rdtb!.n i. O. (hccir! (td 6Et d) of Fdirfic Flit vft lE
.!sl3lc o, idctsl. h m Ey rlDdd tt r..omD.DddioE D. rqrrdld s
S.ot l. tuLa ffi !,.rE . .rd Foru.tniB ir idivdEr qd d Fibir
coDrEt,iti.. my cdrjl dilT.rlE i! tE .9.{:r-r. ryFod r! llE .!4 tE
t@@t,EdiG rbdd ror"bo.n, rd NOL+IE, ..d diriol
judtE or E& or . 6o{o-.a. bci],
LIEEIAIION Lf ADAnICO, rnD (MH.D)
MlLlI{Ira ltl. aTtENz+ i/t-D.
iqLAGROA !l EAUIISIA. M.D.
rAlY t{oREEN C. Crtlr,t tn.D, m.rr)
ALE AI{ITIO A- illNAIDO, M.U (Iu.)
lt GARID e oRnz lt_D.
GEnrrSIS c. RIvERr, itD.
}tf,MBEruI
CouDril on CoEEuoity Scrvic. iod Child Adyo.acy
Co-Di't lorr: C.tr6is C, Riv.n, MD.
Mrr, No]! r C. Chur, MD-
Alcjrrdm A. M.rrrdo, MD.
Mry B. Monr.thno, MD.
Advi..r!: P.dr D. Srnto3 Orlmpo, MD.
Crrm.lirt B. Cuyug.n, MD.
Utro F/ Lin, MD.
ComEilr.. on Clinic.l Pnc,ticc cuiddin !
Chrir: r-.oril, P, Dros,Il-D.
Co-ChriE: F.lizrrdo N, crtchcco, il-D.
J.citrto Bh! Mrol.rnrS III, I(D.
M.ob..!: Mr- Asuncior A- Silv6(rr, M-D.
EiHr Dit.r t- lhvr, il,D.
Judili FraiEr L GrEir. MD-
M& lrudc' C. Mrnio.'' MD.
!

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4. In nrtd lqeg, lne Ph'Ipprne Heak,r Insurane Corporafton requested the
Philipprne Pedrarnc Soc'c(). lnc (PPS. hlc) rhrough i(s Presidenr then D. Zenarda
L Anronro ro mme up $,rrh a Practice Gurde|ne in rhe Approach and Trenrnrcnt of
Urin ry Tract Inleclion in Childrcn in the local ,ettin8. Dr Antonio th€n fo.med a
Tarl( Forc€ i, lh€ PPs with lhe oooperalion ol th€ P€dratnc Nephrology Sociay of
the Philippines composrd ol promined pediarric nepkoloSisrs, a pcdiarric urolo8isr
ar a p€diatric intectioN d;sease speci.,ist. The Sroup hurdled tlre lask olcoming up
with rhe bcst possiblc evidenc€-bas€d clinical practice Suideline (CPG) on UTL
Wirh rhe cr€nrion in :002 oflhe Commftree on Ctinic-al Prrcric. GLrid€lines. as one
of rhe Presidemial Special Projeds (2002 ro 20fi) of Dr Joel S Elises as rhe
hesidetr ot the Plrihppnre Pedralric Socierv. Inc. Dr Elisds i his cutcureN
capacily as the President ollhe P€diatric N€phrolog) Socr€ry ofthe Philippines. lnc
(PNSP) foruarden the 200:l updar€d version of rhe Prscric€ Cuideline
'n rhe
Approach and Treatmert of Urinary lracl tnfection in Children ro be lhe PNSP'S
contribution ro th€ Philippine Pediarric Socie(y, lnc s ComDine€ on Clinrcll Prad'c!
Guidelines
Work oo rhc Pradice Guid€lin€ in tll€ Approach d Tr€alm€d ofunnary
Trad Ir eclion h Childr€n in lh€ Phitippiues S€ttine rfa5 sraned in nid-lCt) upoo
the re4u€n ol The Phrl Herlth lnsnmnc€ Corpor ion mtrrs€d tkough Dr Zenaida L
Adonro, lhe PPS Pr6ident th.n A PPS Ta-sk Forcc on t,Tl was orgnniz€d in
cooperflion wnh rhc P€diarric NcphroloS] Society of rhc Philippines rko',Bh rhr
€ffons of its Pr6ident Dr Myma B Roscl. Thc Tas& Force on IIII ilwolved
repres€rianves ftom the Pedi{tric Neptuolo8y Solicty of the Philippin6 [Dr
Bertri.e B Canonigo, Dr SoDia B Gonzlez, Dr Bettina C Ccrccnja, Dr Dolor€s D
Bonzor Dr Ma Noftu v Zamoril: a Pedidric U.ologis IDr David T Eolongl and a
reprBcnbtive of $c Pcdiat ic Infc{rior! Die..-sc Soci..y of th€ P'hiltpp'ncs [Dr
Jos€fina C Carlosl. The drafls *rrc pass.d around anong comnitrat mcmb.rs and
PNSP m€mbeB for comm€dts ard sugg€stions. By Jsruary ?000, it was pr€s€rted in
a Postgrrdurtc Cours.. [l was $bmitt€d to lhc Philippine P.diarric Soicry April
2ml
FOREWORD
BeiDs one ol rhe nrosr commonl) encouniered abnornul condilions in lhe
p€dBrnc age Broup. rr rs lery surpnsrn8 ro nore rhar lh€ major obslacle rhe 8rorip
mcounrercd $as rhc lack oflell - designed srudics or uials in our counrry l'h,r fi€
Sroup inilrallr aihed for was lo adopl rhe (lPG formulated by lhe Amerrcan
Academy olPe(liarrics aid tr,ade scvssl nrodiliealtons bas€d on rh€ b€st a,va;lable
lileraturc The mar0 ,,ud,0cation lhat the group drd was orr lhr age srDUping Instud
ofrhe 2 nunhs l(, I ve3rs ol rge group, rhe group tlh that lhe CP(i nn! b€ applied
krrhelirll .angeol tcdialric age Sroup funhernxne. Ih€y fe€l lhal *rlhlheus.of
rhis ( l,(;, uod.r dirS osis or olcr trcamrcnt nrny b. aroidcd
The Croup should b€ comnre ded for the e(,aordrmry etlbn rhey exened
rD lhe nrakingol rh,s(PG lt rs also *onhwh'le to nole lhal lhe group mllaled rhe
ben a[d the nron eu, rcnr lircrature !o.ome up Lvrrh a very relevanl and hmely CPG
N. GATCHECO. MD MSc
Prrclict Guid.Iin. in lt. Appmlch tnd Trttlm.nr of lrri .t Trlrr lrf..ti,or
h Ch d-r.! in .hc }}illppin. SGtrirg
Urinary trrct infectior is orlc of ttlc nost commonly ermrmterEd iflfr.tions
itr children. ReqrrEnc€ is hiSh aorc morbidiry is comlnon [.sFcirlly ir the v€ry
youn8] lnd rEnd lcrning may b. i corB.qucDce. Reducrid, in ,€r.i funcrion ard
hyp.rtcrEioo can bc lory rero rEsrlt3. Aca,I'tc dirgtrolir for urirBry tract inf€dbn
is a musl. Urdue diigmsis c{n cerj3c urur€c$lsry work{p, aq€nse ad a deay to
the pareds; udiagnos.d, may r€srll 10 r6ral dsmaSc-
Tltc objccrive srl's lo dorlop r guidclitrc on tli apprGch on UTI on
children in !h! Philippines bar€d on !ailnble accepled evidencc. TtE lrr8d
populalior: childrcn b€low 18 y€rrc old- It is iDt6tded lo b€ us€d by PcJiatricians,
GeneGI pr0clitioners and pediatric cnre aivers
ldend€d htrhh out oroe: ul Re.osniriotr of rh€ child wuh UTl, [2] Mrkins th€
diagrosis of UTI, []l Shon-icfn Eeirment ofUTI,.[4] Evalulrion of rh. child with
UTL [5] Prevemion ofUTI6nd itr coNequencB.
..
MEOLINE drl.ba!. *as :xrrchJ usrtr8 f(xlr $eparate s.ar.h nrA.8lst
Grcsponding wirh rh€ four ph&ses of th€ dia8nosis and rrcatlnefl ofuTl lhe ri(les
and abstmds re$lting from rhe.e searchG w8s dicribul.d amoo8 commilt€.
members who identified lhose aficlcs th3t are defiflttely or pt6nally us€fu|. The
adicles ltrt{e reprodued in tull However, thc Commin.. ba!.d and modcled thi3
Pra.ricc Guidelin on ttE on th€ T.chnicll Repon on "Uriury TrEt Inf.diors io
Febrile Infarts snd YounB Children' of dl€ Arnt{ican Acadcmy oI Pcdiatrics
lPediarrica, Vol l0], No a, April 1999, pp 8al-8521 - lh€ mos compr€heoliv.
doormenl on t Tt in Children exrsting lo dat€
!
(1>Chatr,
U
on Clinical Praclicc CDide!ines
l,rrlcrialB,R€viev of articles w6e erilurted a..ording io gmding [Sorr@
lnftctious Dise{s€ Socidy ofAjn6icl Quilily Standards fo, lnfertiou! Diceaiesl

5. CAIEGORY
cooa cviacncc to s,pport a monrncadation
DEFINMON
Moderale €udeflce to suppoi a re(dfint,datiol fot
B
Poor ct,idlncc to s,pTorl r r€{ornmcDdadon for or
rlFirul use
c
D Modlrdc cvid.oc.lo Eppon a tc.orltrcrdrlti,o
3g3m$ usa
APPNOACE TO I]RINARY TRACT I FECTION M A PEILITPINE
SETTING
E
REPORT BY THg PPl' 7.1.W FORCE ON URINARY TRACT INFECTION
Objcctivc:
To dw€lop a guideline on the approtch on Urinary trrcl infccdon in children in
Philippio.! bas€d or aysilablc acr.plcd evidgr..
Th€ tar8er populrtion: Children below l8 y€3r3 ofage
S.nina Philippin.s
For whom inrerded: P€diaricia4 gencrlt prarthiotrsr alld pediluic c{r€ givcr!
Mahod:
DEFINITTON
I Eviirenix fron s( lc.st one propctly nndomizE4 clntRJled
trial
tr Evidefi€ from d lt€.$ orE ull desiSned mal c/thdn
rlndomiation:
Iiom coho( or cssc coolrolled amllric dudic.:
urcortrolad qp.rimcrtu
III Evidoc.e from ofn ion ofrHpccl.d arthoriti.s, bas.d or
clinical e,ec.i.fte,
D66iptivc a$diq tr rlpdtt ofogart coDlin 6
GRADE
Good evidene to .rrpport a r.co icttddioo a8!in{
t. D€velopmcln ofconc.?tll 6rideoc€ bar€d m6del
2. Dcv€loplIlcln of! D.cisior tr.. bar.d on fic svidcnc. avlil6bl.
3. A comprchcariye revicw ofsvsilablc dsra (lool aad ilnartrdioflrl)
4. Algorithrh basd on colt+ficfit
MODEL
SulptEr-Probrbility of Utt-Dirgmsis of Um-Tre.trEu-Worti4-
-ldlg't.n ff'up
Mar6i.lJReviev of anicle. lhrll be evrlueted rcc..ding lo 8ndin8 (S(rr]ce
Infecrious Dis€rse Society of A.neri(, Qurlity Srandrrds for hf.rtious DirarEes)
To mEd n..d! in the Philippin€ s.tliB, modiFc.tion ir ltE lge offtors h&!
bo.n &rapl€d in ou Suideline. Irst€ad ofcorcerltelng on th. 2 mos to 2 ycrts r8€
8roup, thi3 guidelinc may be spplicd lo dlc tu l rm8c ofPcdiiric.s. go19 I! &ing
so. w. wouid b€ abl€ ro provide lhc clinici&r wirh e bgicrl &td gridic.l ,pprotdr lo
UTI in Children in our sening. RcvBrcns in l.his firs Suid€linc is cxP.ctld end $'ork
will b€ urdE rrlen ai deemtd n€(as$ry.
ofcrch rcaomfl.rddioo foa oa
t
CATEGORY DEFTNTTION
fu evidarca to srpDori a rcoornmandation for uia
B Mod€rdc cvidac. lo suppn r r.molrct|dlrion for use
c Pmr €vidcncc ro salDDon ! rcaommeodation t,{.in3lusc
D Mod.rde rvid.nc€ to suppon a rcoorffircnd.tion agsin{
E fu cvidan(f to suppon n ft.ommcrdrrion rrlinst ui
3

6. DEFINITION
Evdenc€ from
'l
lerlt one proFdy rando,nize4 cornmlled
uid
Eviderre liom rt lesst one w€ll dcsignid in lrial whhout
rudomi"itior. from cohon or crsG-conuoled analyticrl
studi€s uncrnrroll€d €xp€ritueds
m Evidence from opinion oa rGpect€d Nthorili€s, bas€d on
,jlin,cal exp€rienc., descriptive studres, or reF ts ol cxp.ti
rell€d th€ ofcvid.nc€ on which rEcommcndations arc ba!.d
GRADE
TFE CFILD WTTR PROBABLf, IJRINARY TRACT INFECTION
I- ThC SUSPEC|:
I Thc n€omles Fesentiflg wirh th€ clirical signs ard sylnproms a-s pres.nt€d
intable I
2 F€bril€ infonts (r-38 C) b€low 2 )tars ofage (Table I Doi,/fls)
l. Old€r childrcn mrnifstiDg symptoms ref.fable to urimry trflct (Iiblc l)
lllc cv,den(t for rhis r.(oEo.Ddr.iotr A/IL Hob.rnan A (6,7,8): Shary (9),
Dorhs (5)
II ME FOILOVNG LS AN ALGI)RI'TIfi' ON THE DUGNOSL WORX-AP,
TRD'TMENT AND FOLLOW-AP OF CEII.DNEN WIIT UR]NARY TNACT:
NFECNON.
SASPECTED ANNARY TRACT INFECTION
Tablc I
CT,]NICAL
SYMYTOM
ln gcneral
'nanif€statiors
ol urirary tract infecttons 5r€ noD-scicntiffc
However, lhcre are some sigrls lnd symploms thal tre rasocirted uhh UTl.
Irri I sEtr.q rod
<- (+)rq@d.Ewlt
&'crilF,
. Sepric
. Temp€rarure rnsabihy
. Vomiting
. Lethar8y or irrirabiliry
gain/fa ilu re lo lhrive
. Diarrher
. Abdominalpain
o t'rertucncy, drihbling
urSency dysuria
. WeaI Lrrinar y slreim
. Malodorous urine
. Enuresis
.l!q!!!l!s
SIGN/S
l+l
Irj
t+l
+
t+l
tll
)
t+1
[+l
[+]
I+l
[+]
t
5
S.tool At
AdoLrcalat
(}{d.. l 116
lfuhrt'ri
-iirir;at i;Siq;-A;-__-_
9tIdrxl{leedc..1a9lm^)
blwFr%rsr -
c id.dlila.'
4
-rra.!+*odtudtu+xr'
.lfu'&kl6&srEedfu
I
I
{+l
t+l
[+]
t+l
trl
t+1
l+l
t+l

7. III D,jGNOSIS
Initiai urinslysis
r. Cnm slain on an uncentrifuFd urine sp€cimen has tha bq.t s.nsirivity
(0 9l) an/ fals€ po3itiv€ rllc (0.05). f,vidcr.. ir A.[-n
b. Urirc dipstick t€sts h.! a s€nritivity of 0.88 for ihe prcs€n(. of l€ucocylc
estcBse or nitrate A fals€ polhive rslc of only 004 for tlrc pre*ft:r of
cithcr lac.cyle €slcr.s ofnirltc Evid.rGG ii A,
c. Plrria his s lowcr true posiive rale snd highcr frls. posiliv€ ratc: for
prcrenc€ of j'5 WBdhpf in a c€trEiftgcd urin€ th€ TPR was 0.67 and lh
FPR 21, whcrcas for >10 WBC/mml in uncdnrituBrd urine, thc TPR i!
0 77 and FPR 0-l L Gorelicl (10), Doe, (5 rrbl€ 3c.). EvA.rc. ir C/L
CAVEAT
Parall€l combiralions oftest res'llts maxiDizc s€nsitivity. A st dy wilhiD onc hour of
unne collection usi'!ts caretul on-sil. microscopy with r pBitive combmatior for
larkoclres snd bacreria ha3 a s€nsitiviry of99l. or fr€aler. Wh€o any (ampon€t of
rh. urinalylis is positiv€ - such as LE, dtrilc, blood, protejn3, microsropy for
leukocytes. micr ..py ofbsc(efla-. snd rh€ u;n0lysis is (onsidered ar pos'live. th€
s.nsirivirv is 100c" bul th€ spc.ificitv is onlv 60p/-Hobdrun rn, L,olu (ll)
Hott.ron il z), Hobdrn'n ( | l). Evit.,c. it B/Il
UriD. Cultlrr€:
ftIE-COiO STANDARD IS A}TY BACTERIAL CROWTH AFTER A
iijpreruarc iAP rhis is dorc ,n infinrs bctow orr )€ar of asc T'" b]41
"
*i.
"* iii.,."rta"^i"rt. A diaper rhar has been drv fo' rhirtv minur€s sll indiqle
"
Ui"&. *","irlr"s *.rO urine lo avoid ri emptv Lap' wilh a I cr svrirge atd &r
'..1tr, *rr. u i"""at., pundurc ore c€nrimeter abov€ d'c svmpnv!'3 pubn iD d'G
,,aire-1.i, J"'e gi'es rlrat strun a*av fi'om
"uprapubic
laps. corharmzirion would
be thc n€n bcs choic€ Rcf€r to tabl€ 2
Uii_"..rlll ..,"f, in a coop.'.diie md ptoPerly preDd€d patiqn will Sive a high
scositivily and sPccif city.
Table 2
. Urin. CultuE: l.tcrPrti.lion oIUTI
Mdhod ofcollcdix
. Suprryubic Gpirdiqo
Ounidiv. Cuh'Ei Ufl F!s.d
CEMll oI uitrEyldlotcl ir
eD' mEbct (q.qtio n I l,o
2-3 x rd(TLr/Dl ofco.stJcc
ES.rivc st!8/o.dri)
F.b.ib i.frlt 6 t[il&.o ltf,tttly
hlvc 5q000 CFU/ol GrilaE of
a sh8lcorb,ry pdltogE, ht
irluxim E y bc Ft3.!a vith cqd!
nm > Io0(FtltDl (Hoaaoa A
{7).Dosr(7), +
SyEoroorric pt!€ r
'B!.lV
hlrc l0' CFU,hl of n r,Dslc
trrblry ptlhogcn.
AsysdrDaic Pdi.dr r bd
l*o qcorEDr (rt difr(,ttl
D,* sfi tot cRtl otrh..snc
p.rbospr
tras r specincitY of SfZ to
by hp lfonly orltur.. of
, 9i./. @nririvrrv rnd $Pl.
STSTORY:
Chtrl lisl refer to trble I
Iisrory of preuous proven UTI, oollriFiior, voiding disdd.rs si.n 13
incodin€nc., prwious srrgcri€s csp€citrlly pelvic crr8.ri.s, ambul.tory problcm €ac
PE}'SICAL EXAMTNATION:
A drcrou8n pnysical cxaminalion is a must. Thc cxamincI lhqrld loot for conFrital
def€cls thd co€xisls Brck exam alion such as pr€s€nc€ ofdilnpl€s. hair tufls i" th€
lunbosacral ,rc. indiclting probablc ndrogeric bladdcn t w6 qrGrnili6 must
also b€ exrmin€d. ThorouSh ,Erologic cyarniDadoD mul be inclu&d Re.rr,
Exanin&tion is prn of the exrrDination.
URINALYSIS:
Thc urinalysis is rhc foudrtion by which every child wirh lusFcred u.tnary rlrcl
inlirtion would eitlEr hav€ fifih€r wod( up or pr aBid€ for o6!€rvation. A sludy
wnh ! very tugh scishiviy hn low W€qficny wiu Flt childftfl [o urul€ctss.ry
inv8ivc work-up. A nudy with a low scnritivity rrd high sp.cificity will mi!3
children ai rbk of lon8 term conplicdions of urinary fad inlstio
Propcr Coll.cdon of urii.: Thi! ir th. com.r rton of th. .lto.ittlf.
Requirem€nl i
l. for irfarrs bclow one yt,r ofagg s suprqubic le i! rlcoffircrd.d.
2. A c.thd6i"ad urine i! r aood ahcrnalivc to obrrin urinc 4ecimcn.
3. Midstr€sfl urine collection for coop€rstiic psticnB-older girl!.
cirqrmcis.d boys ad old.r boys who3c forcsttu is .asily rltad.d.
+ Cu[ure ofurin€ specimcns obtained by catheteriziiion
89ry. compued with cukur6 of urine sp€cimens obiained
carh€t€riz.d orltures have
>looocFtr/ml sre con3idered,
speciticity
Routine reollluring - of lh€ unne afler 2 days ofadimicrobial thenpy is
ameratlv not necessarv if the intanr or ,oung chitd htos ll'd crpcdcd
iini*ti..p"n* ",ta
ric
'rop{hoBeD
is ddermincd tu b€ scdhiv' ro the
antimisobial b€inE.adrnini3rt'd
1
6

8. WARNINC ON TEE USE OT BAC SPECIMEN FOR CULTURE:
Cuhure ofb.g spccimen is 100/0 rensitive br have a spelifichy of only 14-84%-
Taylor ( la). Pueno M ( l5) With prevalance rde ofonly 5%, tbe l1r€ of ()llture 6'oflr
lhe urin€ sFcimens fiom a bag to rule in UTI ir likely ro result in a largr number of
frlse positiv€ resulrs Sp€cifically, wilh p.e!"lenc€ of 5% Thal is,85./oofpositive
orhures ofbaS specimen would bc frlse Dol*n(5). gvid.ncc is D/tl
by
VCUC
Dom(5) 5t9 toty/o
VTJR
tb$r (5) 3t% tw. Alt
EurbiE. KA
(15)
ChildM 75% 25-stf/r |t/.
(imlbCirg
lvP)
EorT
Hzolni AY
(17)
Ctil&a tof/.
Sucllic JM
(lE)
udq 14 7<t/" 2<f/, tw.
DMSA
( te)
I- ,lr! !!d
1T/.
Nol ulctul togt
(20)
to0/.
virh
UTI
Mu.ci B
(2t)
Childo
Childrcn (sirb)
14.1, 1% DlttSA.s !
Skitc(22) a% tl% l00p/"
(23)
Clxklrcn
43%
UlrrasonoSraphy alone as a *o.kup for p ients wirh Prolen urin rv Lrafl infe.lion is
inadequare lr is sensjti'e(99-95o/, Cl96%'toff/o)but il irs' tP€.ificitl' ,nod€sl (41-
1.;129lc55%). Ricklvood (23) Evid.rc. i! A-4[
l'he Lrse ofvoiding cy$ourelhrography tlr nuclelj cvslogram) evahates rh€ prelenc€
o. abs€nc€ of vesicoureteml retlur.
'esicouretqal reflux is th€ n)osr common abnormaliry found ir_patienls wirh uinaty
rrac{ rnfrcnon The pr€valercc is loelo to 40oi ' Dom (s-rshlc 6 and lable ? r6'iew
ol ltr.rarur.) Evideoc. h A,/[
I'. 7 REA'|]V ENT:
. Som. rrrimic.obirb for or.l lre.tmcol o[I]Tl
Amoxicillin 20 40 mg^S/&v in I doses
TMP h conrbinalion qith SMX Gl2 fiBTMP 30{0 S},0{pcr
kt p€r day in 2 doses
Su lfisoxaz ole 120- I 50 ftg/tEldav in 4 dos€s
Cefixi,r. 8mg,&8/daYh2do!€3
CephAlerin 50100 n'8/t8/drv in 4 dos€s
Cefidotine Io mgkglday ;i 2 dos€s
Ceforozil l0 ms,&Cday in 2 dos.s
t.ora.ubef 150-10 msACdaY in 2 dos6
. Son'r $olibiolics for prr€nlrl treiltmenl ofUTl
( clinalo.c ?5 mg^t cvt'Y 24 hou6
150 ms,4elday divided every 6
150 mg/kdday divided evcry 6
Celizol;n s0 nslkgdzy drvided ever)' 8
Iv. |+'oR.x.uP
T5ble 3
9
(2at
Childro
8
tt%
Gcnramicin 7 5 m8,4(8,/day dividcd ever.v E

9. 5 ou^g/day div'dd evEry S
Ti(,rciltin
3$ nwtkgday d;vi,ded evdj 6
Ampicillin
lo0 mgAg/day divided every 6
PmplJhcric ,ntibiortu - low scnJm t€vets bur wilh his, urinsrv Ievct
- Hrs minimal effeds on feca, flora
Low cosr and well rotaat€d
% ofthc regular dole given sr b€dtime
Sooc m.imicrobirl for pmhyt i, of UTI
TMP in combrnarioo wirt SMX
kg rs singtc bedrime dose
SIO{ F Ig rwic€ p€, ,c.k
Nitrofumtlloi
l-2 mg/k8 as sirgte daity dose
lG20 g/tg drvided every t2
Nalrdixic Acrd
6 HobermanAlrrald ERR.ynolds EAPenchansty LrchffrDn M;Is urine
cukur. necessary ro rule out uinary roct infecton in yolng fe$rile
children? P€d Infecl Dis, 1996 Apn l5(1).lo+9
7 Hob€nnan,A, Wald E& Rcynolds EA Petlclrrrsky L, Chanon;PyGia
and bacle.iuria in urine spetimens ohlained cltheter fo.fr young
children with fever, J Pediadcs lee4 Api 124 (4) 513'9
8 Hobman A. Chao t{P. Kells DM Hictey R, Davis ttw Ellis D
Prevalence or unrary rracl ,,rfectio in febril. nfants J Pediatr l99l
lul.123(tl li-23
I Sluw K. Mcgo*a, K, Go.elick MH, Shawaru .,S. Scr€snin8 for
orinary tracl infection in dl. Emerg.rrcy D.parmcnt. which tcd is
Be$' Pediirrics Vol I 0 I No6. Iun€ I 998
l0 Gorelick MH, Shaw K. Screening for Urinary Eld infettjon in
Children L,leranrulysis. Pedinrrics Vol lM NoJ Norrmbg1999
ll LohI JA, Po(illr ,VG, G€uder TG, Durn ML, Dudlcy SM. Maf,ing a
pr€sumbpriv€ diatsnosrs of rinary tracl inlirion by usinS a urioalysig
perfomed in an or-sit laborarory J Pediatr 1994 124.513-9
12 Housron IB Pus clll and baclerirl cou s in rh. dil8n8is for urinary
lrrd inf€crions in childhood. A'ch Dis Chil 1961 38 6O0iO5
ll Hobermrn A wald ER Pdchrnsky L. Reynold! EA YoirlB S.
Enhanced urinalysis rs s screning for uriaary tracl infectror Pediatrics
1993;91 I l96l199
14 Toylor CM, White RH The fersibililv of s.re€trin8 presclrcol children
for urinari tract irfection usinS dislides r J Pedirr Nephrol l98l Jun;
(2):lll-a
l5 Pue4o M, De Julian C. Soro M, Del Pozo S. Arador R Perioeal bag vs
cllheledzarion ot' suprapubic aspirarion tbr ihe diaSnosis oa LiTl in
infants in eme.geMy room
It' BurbrS€ K-A, Rd'k AB, Colodny A}1 Bauer SB. Lrbowirz R tlflnary
tracr infeclion in aoys I (,ml 1984 Sep il2(l) 511
17 Elzouki AY. Mir NA l.swal OP. symprornatic urinary trad infcron
in pediairic patie,ts-a dcv€lopmental aspecr lot J Peiiotric Nepluok'gy
1985 Oct-l}}L: 6(4).:67-70
l8 Snrellie JM. Ridgen SP, Prescod NP tionary rract infecuon a
comparison of four melhods of i8vesri-qation Arch Dis Child l')e5
Ma! , 12O) i4'1 -50
l9 Hoberman d wald ER UrinnD' t6c1 lnfccrions in lour febnle
Children Pediatn lnfec DisJ I9q7 Jan l5(l) ll-7
20 Hnaoka M, Hashrmoto C, Iiori C. T$chrda S. Ttullhara II.KoDsho
Y, Strdo M t,lrra$nography lor lie delecli(u ol uretenc fttlur rr
rnfanrswrlh urinary tractinfeclrcn Acla Paedlr Ipn Jun, l8(l)21E-51
2l Mucaj 8i Maqu;Ee B Do€s rouriDe ultrasound have a role i, Ihe
investigalion ofchildren with urinary tracl infecliotr'Cl,n Radiol lgq4
N.{ay.49(5) 124-5
2? Slrite JL. Bissei GS. Kirks DR- Schlueler FJ. Celland Ml. BakrkI
KKDS. tlan Bl Nuclelr cynography aid rcnal uftrasono.rrath
2 ms TMP,l0 n'a of SI!O( Fr
Or 5 m8 of rup, 25 mg of
Mahcnamine rundetate
l0 m-!,&g dividd €very 12
75 mylg drvrdcd wcrj 12 hours
I
Biblio8raphy
I
).1-u1.
sn, sulolor) B {rmpromar,c ard rpro,nar,c @nirv r,a(r
rnlnl!n rn rnhn.r
Am.l DrsChrld r9rt, t:S,$-tl
.' Mc Intvre PB. crav Sv, vancc JC Un$specld rnfedions in febrit€
connrlsions Med J Au{ lq9o. I52. lEl
i Prvl.r C Ludcrs D The badenolo,r ut the urine in rrfa rs an,J
. chrldr€n Errh gavroenrenls I'eU,"r..s i6or, sr/-ESr
I snofllrle I h.z I nnarr trld rrt<.1ion rn infanr, and .hrtdftn
.
( an'pbe.lli. 7'eJn,on t.trh. Reuct Vaughn. U,ein
rntanrr !d un$ Chrtdrcn, pq.tErrics Vut I0t oa Apnl
t0
tl

10. findinSs in Birls !!ith urinary traa infedion AJR Am J Roenrg€trolo8y
1989 Jul, l5l(l). ll5-9
2l Rickwood .AM. Carty I{M, McKendrick T: Wrllialns MP. Jackson M;
Pillirg Dw, Spri!,g A Cunent ima8ing of childhood unnat/ tracl
inl-ections ProsJ,€clive $Ney
a
DISCI,ATMER
TIE ltou@drrioE @fllEd in dF (h{utrEr of & Phlrr?r P€dnm
Soccg. Iirc . CotrDitre on Cldial Po.re Gur.hli6 aE n{.rtr lo CUIDE
pr.ExioEE in rh. da4lDn r td tr@gemnl) of p.rlElnc FIEflt rnt ttt
tlsss or rfi.En tn m ra ilb ld rhe eomren&noc h. e!,d4d as
iberur! nrr6. ,e MEd a'n IE.uliarni6 in i6dNii'.1i:B d |Rdanlar
cdrl dilleclB rn rlr sp.cfr apD'lrn In rlr. .ll.
l6IMcnd,1lro6 dE d s'pphmrI. d NOT rrle sDld ctnsl
'dA
Err nBdc on a €*foqcbis's
ThG acliyities of rh. Cor|Eitt . oo Cliricrl Prr.tk. GuiddiD6 ry.rt prnly
iupponed by rn.ducrtiond gr.nl from S ofFsyrlhehta
I
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