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Application of low-risk criteria for and approach to the febrile infant: A reasonable approach for treating febrile infants younger than 2 months who have a temperature of greater than 38°C.

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Table 1. Urinalysis for Presumptive Diagnosis of Urinary Tract Infection*

Method	Findings
Bright-field or phase-contrast microscopy of centrifuged urinary sediment	Bacteria
Gram stain of uncentrifuged or centrifuged urinary sediment	Bacteria
Nitrite and leukocyte esterase test	Positive = UTI likely
Nitrite test	Positive = UTI probable
Leukocyte esterase test	Positive = UTI probable
*Negative microscopic findings for bacteria do not rule out a UTI, nor do negative results of dipstick testing for nitrite and leukocyte esterase. False-negative nitrite readings are especially common in children.

Table 2. Quantitative Urine Culture for the Diagnosis of Urinary Tract Infection*

Method	Finding
Suprapubic aspiration	If a UTI is present, bacteria are likely to be proliferating in bladder urine with growth of any organism except 2000-3000 CFU/mL coagulase-negative staphylococci.
Catheterization in a girl or midstream, clean-void collection in a circumcised boy	Febrile infants and children with UTI usually have >50,000 CFU/mL of a single urinary pathogen; however, UTI may be present with 10,000-50,000 CFU/mL of a single organism.*
Midstream, clean-void collection in a girl or uncircumcised boy	UTI is indicated when >100,000 CFU/mL of a single urinary pathogen is present in a symptomatic patient. Pyuria usually present. A UTI may be present with 10,000-50,000 CFU/mL of a single bacterium.*
Any method in a girl or boy	If the patient is asymptomatic, bacterial growth is usually >100,000 CFU/mL of the same organism on different days. If pyuria is absent, this result probably indicates colonization rather than infection.
*Patients with urinary frequency (ie, decreased bladder incubation time) are those most likely to have bacteria proliferating in the urinary bladder in the presence of low colony counts.

Table 3. Antibiotic Agents for Parenteral Treatment of a Urinary Tract Infection

Drug	Dosage and Route	Comment
Ceftriaxone	50-75 mg/kg/day IV/IM as a single dose or divided q12h	Do not use in infants < 6 wk of age; parenteral antibiotic with long half-life; may displace bilirubin from albumin
Cefotaxime	150 mg/kg/day IV/IM divided q6-8h	Safe to use in infants < 6 wk of age; used with ampicillin in infants aged 2-8 wk
Ceftolozane/tazobactam	30 mg/kg IV q8h x7-14 days	Indicated for complicated UTIs approved in children from birth and older; CrCl must be above 50 mL/min/1.73 m²
Ampicillin	100 mg/kg/day IV/IM divided q8h	Used with gentamicin in neonates < 2 wk of age; for enterococci and patients allergic to cephalosporins
Gentamicin	Term neonates < 7 days: 3.5-5 mg/kg/dose IV q24h Infants and children < 5 years: 2.5 mg/kg/dose IV q8h or single daily dosing with normal renal function of 5-7.5 mg/kg/dose IV q24h Children ≥5 y: 2-2.5 mg/kg/dose IV q8h or single daily dosing with normal renal function of 5-7.5 mg/kg/dose IV q24h	Monitor blood levels and kidney function if therapy extends >48 h
Note: CrCl = creatinine clearance; IM = intramuscular; IV = intravenous; q = every; UTI = urinary tract infection.

Table 4. Antibiotic Agents for the Oral Treatment of Urinary Tract Infection

Protocol	Daily Dosage
Sulfamethoxazole and trimethoprim (SMZ-TMP)	30-60 mg/kg SMZ, 6-12 mg/kg TMP divided q12h
Amoxicillin and clavulanic acid	20-40 mg/kg divided q8h
Cephalexin	50-100 mg/kg divided q6h
Cefixime	8 mg/kg q24h
Cefpodoxime	10 mg/kg divided q12h
Nitrofurantoin*	5-7 mg/kg divided q6h
*Nitrofurantoin may be used to treat cystitis. It is not suitable for the treatment of pyelonephritis, because of its limited tissue penetration.

Table 5. Antibiotic Agents to Prevent Reinfection

Agent	Single Daily Dose
Nitrofurantoin *	1-2 mg/kg PO
Sulfamethoxazole and trimethoprim (SMZ-TMP) *	5-10 mg/kg SMZ, 1-2 mg/kg TMP PO
Trimethoprim	1-2 mg/kg PO
Do not use nitrofurantoin or sulfa drugs in infants younger than 6 weeks. Reduced doses of an oral first-generation cephalosporin, such as cephalexin at 10 mg/kg, may be used until the child reaches age 6 weeks. Ampicillin or amoxicillin are not recommended because of the high incidence of resistant E coli.*

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Author

Donna J Fisher, MD Assistant Professor of Pediatrics, Tufts University School of Medicine; Chief, Division of Pediatric Infectious Diseases, Baystate Children's Hospital

Donna J Fisher, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Healthcare Epidemiology of America, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society