RepertoireClinical template workspaceFree Self-Assessment
Febrileinfant 8-60daysConstipationFeverUTI

Urology

UTI

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Febrile infant 8-60 days

Comes up in this visit

ConstipationFever

Template

UTI

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Counseling

If antibiotics were started, fever and pain should improve within a couple of days; give every dose and finish the course unless we call to stop it after the culture. Recommended supportive care with an emphasis on plenty of fluids and regular, unhurried bathroom trips. Return precautions given including fever that is not improving, vomiting or not keeping medicine down, back or side pain, decreased urination, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

  • Febrile UTI or concern for pyelonephritis
  • Cystitis without fever
  • UA consistent with UTI: culture + empiric oral antibiotic
  • Culture positive: antibiotic per susceptibilities
  • UA without pyuria: UTI unlikely, no antibiotics
  • Equivocal UA: culture, antibiotics held
  • ED or parenteral (< 28 d, ill-appearing, bacteremia, can't take PO)
  • Single dose of ceftriaxone before oral when prescription access is uncertain
  • Cephalexin (Keflex) first line; cefixime, ceftriaxone, TMP-SMX, ciprofloxacin by local resistance
  • Nitrofurantoin for older-child cystitis
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  • Stop antibiotics if culture negative
  • Change antibiotic per susceptibilities
  • Renal and bladder ultrasound after first febrile UTI
  • VCUG with abnormal RBUS or second febrile UTI
  • No routine prophylaxis for low-risk VUR; refer high-risk VUR
  • Evaluate and treat BBD/constipation
  • Fever should improve within 1–2 days; finish antibiotic; fluids; return precautions

Used to decide, kept out of the note

  • Evaluate within 72 h
  • No routine VCUG after first febrile UTI with normal RBUS

Return precautions in the template

fever that is not improvingvomiting or not keeping medicine downback or side paindecreased urination

Sources