As mentioned before, early treatment of UTIs, especially in infants and young children, decreases the risk of kidney damage. Table 136:2 summarizes the approach to management of children with UTI. Inpatient management should be instituted for any child less than 3 months of age with a febrile UTI; children who have significant dehydration or appear toxic; those with pyelonephritis, urinary stents or other urinary foreign bodies, or renal insufficiency; or those who are immunocompromised. In addition, if a child's compliance and follow-up is questionable, inpatient or pediatric short-stay unit treatment should be considered.
Children older than 3 months with febrile UTIs who appear nontoxic and only mildly dehydrated and who do not have persistent vomiting may be rehydrated in the emergency department. These children may initially receive intravenous antibiotic therapy and may then be discharged home on a course of oral antibiotics. Prior to discharge, they should demonstrate adequate oral intake and retention of fluids and have arrangements made for follow-up care within several days either with the primary care physician or the emergency department. Specific antibiotics and their dosing for both inpatient and outpatient therapy are contained in Table 1.3.6.-3, but therapy should be guided with an understanding of the antibiotic resistance patterns in the hospital and community. Instructions should be given to the caregiver regarding follow-up on culture results.
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