>6 years old?
>11 years old?
Phenazopyridine (Azo, Pyridium) PO TID x 2 days
Note: If patient is a non-toilet trained child consider using Curbside pathway: 'Pediatric UTI (2 mo - 24 months)'.
Cephalosporin allergy?
Consider pediatric consult
Consider other source OR wait for culture with PMD in 24 hours
- Other clinical concern for UTI
- Urinary or abdominal complaints (not asymptomatic bacteriuria)
- Complicating functional or anatomical urologic history
- Toxic appearance
- Non-toilet trained
- Male
- Pregnant
Pregnant?
Vaginal discharge or irritation?
Dysuria AND frequency present?
Well appearing?
>11 years old?
Pelvic exam if appropriate, consider empiric treatment for STI
Consider other source OR treat empirically for UTI
Presumed UTI on UA?
Meets discharge criteria?
Contraindications to probiotics?
Probiotics
Symptoms of pyelonephritis?
Cephalosporin allergy?
Discharge criteria
- Reassuring vital signs
- Tolerating PO
- Well-appearing
- No social/family concerns
- Reliable follow up in 24 hours
- Parents comfortable and understand discharge plan
- Provider comfortable with outpatient therapy
Give both antibiotics
Urine test Interpretation
- Presumed UTI (UA Pyuria)
- Positive nitrite or leukocyte esterase and microscopy showing bacteria or > 10 WBC / hpf
- Definitive UTI (Urine culture)
- Urinalysis that suggests infection (pyuria and/or bacteriuria) AND one of the following:
- Suprapubic aspiration: > 1,000 cfus
- Catheter sample: > 50,000 cfus (often reported as 10-50,000 cfus depending on lab)
- Clean catch sample: > 100,000 cfus
- Urinalysis that suggests infection (pyuria and/or bacteriuria) AND one of the following:
Assess for risk factors:
- History of UTI
- Abdominal or back pain
- Dysuria
- Frequency
- New-onset incontinence
- Fever > 38 C (100.4 F) without a source
Consider other source
Excluded from pathway
Any of the following present?
- < 11 years
- Previous UTI within last 3 months
- Symptoms of pyelonephritis
- Complicating factors for UTI
Complicating factors
- Male
- Elderly
- Pregnancy
- Atypical symptoms
- Nosocomial infection
- Diabetes, immunosuppresed, organ transplantation, cancer
- Previous GU surgery or anatomic abnormality, recent GU instrumentation, indwelling catheter or other GU foreign body
- Renal failure, oliguria or chronic kidney disease
- Recent history of sexual abuse
- Failure to respond to initial therapy
Bactrim BID x10 days
