DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS 
These consensus guidelines, developed by the Northern California Pediatric Hospital Medicine Consortium, integrates current evidence and expert consensus to standardize pediatric UTI management. They emphasize diagnostic accuracy, appropriate antibiotic use, and imaging strategies to reduce overtreatment and improve outcomes. Evidence quality is moderate, with recommendations grounded in clinical studies and expert agreement.
⚕️ Key Clinical Considerations ⚕️
- Urine Collection: Catheterized specimens are preferred for culture in non-toilet-trained children; bag specimens are discouraged due to high contamination risk, which can lead to misdiagnosis and unnecessary treatment.
- Urinalysis and Culture: Both are required for diagnosis in children under 6 months; older children need culture only if urinalysis is positive and symptoms are consistent with UTI.
- Empiric Antibiotics: Recommendations vary by age and clinical presentation; ceftriaxone and cefixime are commonly used, with adjustments based on local resistance patterns and culture results.
- Imaging Guidance: Renal and bladder ultrasound (RBUS) is recommended after the first febrile UTI in children under 24 months to detect structural abnormalities.
- Hospitalization Criteria: Infants under 2 months, toxic appearance, vomiting, or inability to tolerate oral antibiotics warrant inpatient care and parenteral antibiotics.
🎯 Clinical Practice Impact 🎯
- Patient Communication: Educate caregivers on proper urine collection and the importance of follow-up imaging.
- Practice Integration: Incorporate catheterized collection protocols and age-based antibiotic pathways into EMR order sets.
- Risk Management: Reduces misdiagnosis and antibiotic overuse by discouraging bag specimen cultures and emphasizing culture confirmation.
- Action Items: Train staff on catheterization techniques; update clinical pathways; monitor adherence to imaging and antibiotic guidelines.
- Resource Implications: May increase short-term imaging use but reduce long-term complications and hospital readmissions.
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