Dysuria, UTI and Pyelonephritis (2 - 18 years)

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Dysuria, UTI and Pyelonephritis (2 - 18 years)

>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

Inclusion Criteria
  • Other clinical concern for UTI
  • Urinary or abdominal complaints (not asymptomatic bacteriuria)
Exclusion Criteria
  • Complicating functional or anatomical urologic history
  • Toxic appearance
  • Non-toilet trained
  • Male
  • Pregnant


Vaginal discharge or irritation?

Dysuria AND frequency present?

Well appearing?

>11 years old?

Urine Pregnancy, Urine

Pelvic exam if appropriate, consider empiric treatment for STI

Urinalysis with micro, Urine

Consider other source OR treat empirically for UTI

Presumed UTI on UA?

Meets discharge criteria?

Contraindications to probiotics?


Symptoms of pyelonephritis?

Cephalosporin allergy?

Ceftriaxone injection
Admit to Floor

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

Admit to Floor
Gentamicin injection

Give both antibiotics

Ceftriaxone injection
Cephalexin suspension

Cephalexin suspension

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

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

Urine Culture, Urine

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

Nitrofurantoin monohydreate/macrocrystals