by Nicole Evans M.D.

Created on: October 17, 2009   Last Updated: October 18, 2009

A urinary tract infection in a child or infant older than two to three months of age may often be treated as an outpatient (outside of the hospital) with oral antibiotics. However, urinary tract infections in young children are potentially serious infections, sometimes requiring hospitalization, IV antibiotics and imaging studies if severe enough.

An untreated urinary tract infection that starts in the bladder, termed cystitis, may ascend to infect one or both of the kidneys. An infection of the kidneys is called pyelonephritis, and can cause scarring of the kidneys. This scarring may lead to permanently impaired renal function.

In a worst case scenario, infection may lead to urosepsis in untreated or incorrectly treated children. Urosepsis is a dangerous, potentially lethal, condition in which the infection in the urinary tract reaches the bloodstream and/or causes an overwhelming inflammatory response of the entire body.

Indications for Hospitalization

The following symptoms and conditions may be indications for hospitalization in a child with a urinary tract infection:

-Age less than 2 months

-Clinical urosepsis or potential bacteremia (bacteria in the blood)

-Immunocompromised child or infant (HIV, inherited condition, sickle cell disease, etc)

-Vomiting or inability to tolerate oral medication

-Lack of adequate outpatient follow-up (eg, no telephone, child lives far from hospital, etc.)

-Failure to respond to outpatient therapy (clinical condition of most patients improves within 24 to 48 hours of initiation of appropriate antimicrobial therapy)

Empiric Antibiotic Therapy

In infants with a urinary tract infection, a delay of greater than 24 hours before beginning antibiotic therapy is associated with an increased frequency of renal (kidney) involvement. However, this has not been shown to correlate with permanent renal damage.

In most cases, a doctor will start antibiotics before he or she receives the results of the urine culture back. This is called starting empiric therapy. In other words, antibiotics are used which are known to be effective against the most common bacteria that cause urinary tract infections in kids. Once the culture is back the doctor can change the antibiotics if necessary.

First line antibiotics for urinary tract infections in kids:

-2nd or 3rd generation cephalosporins (eg, cefprozil, cefpodoxime, cefixime [ORAL], cefotaxime, ceftriaxone)

-Aminoglycosides (eg, gentamicin, amikacin)

-Add amoxicillin or ampicillin in children

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