UTI in young children: how to diagnose (urine sample) and treat in primary care?

Urinary tract infections (UTIs) in young children should be diagnosed based on symptoms, signs, and urine testing as outlined in NICE guidelines ¹.

Urine samples should be taken before antibiotics are administered, using a clean catch method if possible, or other non-invasive methods such as urine collection pads; catheter samples or suprapubic aspiration (SPA) are used when non-invasive methods are impractical ¹.

Urine preservation involves refrigerating or using boric acid if the sample cannot be cultured within 4 hours, following manufacturer instructions ¹.

Urine testing includes dipstick testing for leukocyte esterase and nitrite in children aged 3 months to 3 years; if both are negative, antibiotics are not given, and further testing is not routinely necessary unless specific criteria are met ¹.

For children aged 3 years or older, urine dipstick results guide management: if both leukocyte esterase and nitrite are positive, assume UTI and start antibiotics; if only one is positive, send urine for culture and consider clinical context before prescribing antibiotics ¹.

In children under 3 months with suspected UTI, urgent referral to paediatric specialists is recommended, with urine sent for microscopy and culture ¹.

Management includes appropriate antibiotic treatment based on age and risk factors, with first-line options such as trimethoprim or nitrofurantoin for children over 3 months, and consideration of ultrasound to identify structural abnormalities ¹,².

Recurrent UTIs should be managed with specialist assessment, investigations, and consideration of prophylactic antibiotics if indicated, with ultrasound and DMSA scans to assess renal health ².