Paediatric urinary tract infection (NICE guideline)

Dr Owen Kang and Dr Bruno Di Muzio et al.

The British National Institute for Health and Care Excellence (NICE) published the “Urinary tract infection in under 16s: diagnosis and management” in 2007 as a guideline for paediatric urinary tract infection (UTI) management, including imaging, prophylaxis and follow-up 1

This article intends to summarise only the imaging approach proposed by this guideline.

  • atypical UTI
    • seriously ill 
    • reduced urine flow
    • abdominal or bladder mass
    • increased creatinine levels
    • septicaemia
    • failure to respond to suitable antibiotics in the first 48 hours
    • infection with non-E. Coli organisms
  • recurrent UTI
    • 2 or more episodes of UTI with acute pyelonephritis, or
    • 1 episode of UTI with acute pyelonephritis and 1 or more episode of lower UTI, or
    • 3 or more episodes of lower UTI

Clinical examination and laboratory tests are considered sufficient for UTI diagnosis, and so, routine use of imaging or this purpose is not recommended.

Only infants and children with atypical UTI should have an ultrasound of the urinary tract during the acute infection. Imaging will help in identifying structural abnormalities of the urinary tract such as obstruction.

  • ultrasound 
    • infants and children who have had a lower urinary tract infection should undergo an ultrasound study within six weeks only if they are younger than 6 months, have had atypical UTI, or have had recurrent infections
  • DMSA
    • DMSA scan 4 to 6 months following the acute onset should be considered to detect renal parenchymal defects, if
      • younger than 3 years and has had an atypical or recurrent infection 
      • older than 3 years and has had recurrent UTI 
  • micturating cystography
    • routine imaging to identify vesicoureteral reflux (VUR) is not recommended for infants and children who have had a UTI, except in particular circumstances, such as
      • younger than 6 months and has had an atypical or recurrent infection
      • between 6-month-old and 3-year-old, only if 
        • ureteral dilatation/hydronephrosis on ultrasound
        • reduced urine flow
        • non-E. Coli infection
        • family history of VUR
    • for micturating cystourethrogram (MCUG), prophylactic antibiotics should be given orally for 3 days with MCUG taking place on the second day
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Article information

rID: 48065
Section: Approach
Synonyms or Alternate Spellings:
  • NICE guidelines for UTI
  • UTI in children British imaging guidelines

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