Lower UTI
Guidance is for patients 3 months and older.
For patients under 3 months refer to Sepsis under 1 month or Sepsis 1 month and over
Obtain Urine sample for dipstick or microscopy AND culture prior to starting antibiotic therapy.
Take account of previous antibiotic treatment and prior culture results when choosing empiric antimicrobial therapy.
Review antibiotic choice once culture results are known and narrow spectrum of activity if possible.
Treat for 3 days
Preferred (including non-severe penicillin allergy)
cefalexin 12.5mg/kg (max 1g) po TDS
OR
nitrofurantoin* po if able to swallow tablets **
- up to 11 years: 750 micrograms/kg po QDS
- 12–17 years: 50 mg po QDS
*risk of hepatic and pulmonary adverse drug reaction (see MHRA Drug Safety Update). Use with caution in patients with pulmonary disease or hepatic dysfunction. Monitor for new or worsening pulmonary or hepatic dysfunction symptoms.
**if unable to swallow tablets and nitrofurantoin is the only therapeutic option, please contact paeds ID or a paeds pharmacist to discuss the use of suspension (non-formulary) or alternative options
Alternative
penicillin allergy (severe)
ciprofloxacin+10 mg/kg (max 750mg) po BD
+ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution
OR
nitrofurantoin* po if able to swallow tablets**
- up to 11 years : 750 micrograms/kg po QDS
- 12–17 years: 50 mg po QDS
*risk of hepatic and pulmonary adverse drug reaction (see MHRA Drug Safety Update). Use with caution in patients with pulmonary disease or hepatic dysfunction. Monitor for new or worsening pulmonary or hepatic dysfunction symptoms.
**if unable to swallow tablets and nitrofurantoin is the only therapeutic option, please contact paeds ID or a paeds pharmacist to discuss the use of suspension (non-formulary) or alternative options