Urinary Tract Infections and Vesicoureteral Reflux

Workup with fever without obvious cause, from Campbell's

Pediatric antibiotic dosing, from Campbell's

Pediatric UTIs

General considerations and risk factors

Follow up imaging

Treatment considerations

Other Infections

Antibiotics for UTI

Antibiotic Dosing N/V/D Rash Other side effects
Nitrofurantoin 3-5mg/kg/d, BID Yes No Hyperbilirubinemia if given < 3mo old
TMP/SMX 8-10mg/kg/d (trimethoprim), BID Yes Photosensitivity
Augmentin 20-40mg/kg/d, TID No
Cephalexin 50-100mg/kg/d, QID Headache
Cefprozil 20mg/kg/d, BID

Causes of secondary reflux, from Campbell's

VUR severity grading system, from Campbell's

VUR severity visualization, from Campbell's

Vesicoureteral reflux (VUR)

Considerations

Tenets of VUR management

Antibiotic prophylaxis

Endoscopic management

Surgical management

Randomized Intervention for Vesicoureteral Reflux (RIVUR)

Age Group IF... THEN...
< 1yo Hx febrile UTI + VUR (Grade I-V) Start abx ppx
VUR (Grade III-V), no hx febrile UTI Start abx ppx
VUR (Grade I-II), no hx febrile UTI Consider abx ppx
Male w/ VUR or febrile UTI Consider circumcision
> 1yo BBD present Manage BBD (will make VUR treatment more difficult)
VUR + BBD and/or febrile UTI Start abx ppx
VUR without BBD, febrile UTI, renal anomalies Consider starting abx ppx
All ages Breakthrough febrile UTI on abx ppx Surgical intervention (reimplant vs deflux) vs switching abx
Worsening renal function, abnormal US, equivocal reflux, breakthrough UTI Consider DMSA scan
Non-febrile UTI Consider abx ppx (can be non-febrile pyelonephritis)
Asymptomatic on abx ppx Annual BP, BMP, renal US
Surgical intervention Consider renal US +/- VCUG to assess for resolution
Febrile UTI after surgical intervention Rule out BBD, obtain VCUG
Resolved reflux (Grade 0-I) Discuss stopping abx ppx
Sibling with VUR Workup only if renal anomalies or size asymmetry, or hx UTI

References