- If the child is unwell, culture them as you think is appropriate and treat.
- In well appearing children, UTI does not seem to cause long term renal problems and the risk of sepsis is incredibly low.
- In well appearing children, there does not appear to be a difference between starting antibiotics for UTI on the first day of fever or on day number 5.
- Given the rate of asymptomatic bacteriuria, you should anticipate a high rate of false positive urine cultures.
- Therefore, it makes sense to wait until at least the fifth day of fever before testing for UTI. This will result in fewer urines being sent and fewer false positives (because many fevers will resolve before day 5), but does not seem to be associated with any harm
- There does not seem to be any value in routine imagining of children with a first time UTI. Selective imagining based on history and physical makes more sense, but even then it is not clear that imaging changes management.
