ED - Theraputic Dysuria, UTI and Pyelonephritis (> 2 years)
Last Updated: 5/10/2016 4:20:45 PM
Order Set
  Associated Pathway(s)
 Dysuria, UTI and Pyelonephritis (2 - 18 years) - http://www.curbsideup.com/link/9
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  Inclusion Criteria
Inclusion Criteria ( Any one criteria present )
  • Other clinical concern for UTI
  • Urinary or abdominal complaints (not asymptomatic bacteriuria)
Exclusion Criteria
  • Complicating functional or anatomical urologic history
  • Toxic appearance
  • Non-toilet trained
  • Male
  Urine test Interpretation

Presumed UTI (UA Pyuria)

  • Positive nitrite or leukocyte esterase and microscopy showing bacteria or > 10 WBC / hpf

Definitive UTI (Urine culture)

  • Urinalysis that suggests infection (pyuria and/or bacteriuria) AND one of the following:
  • Suprapubic aspiration: > 1,000 cfus
  • Catheter sample: > 50,000 cfus (often reported as 10-50,000 cfus depending on lab)
  • Clean catch sample: > 100,000 cfus
  Confirmatory testing

Complicating factors

  • Male
  • Elderly
  • Pregnancy
  • Atypical symptoms
  • Nosocomial infection
  • Diabetes, immunosuppresed, organ transplantation, cancer
  • Previous GU surgery or anatomic abnormality, recent GU instrumentation, indwelling catheter or other GU foreign body
  • Renal failure, oliguria or chronic kidney disease
  • Recent history of sexual abuse
  • Failure to respond to initial therapy
  Previous UTI within last 3 months, < 11 years, symptoms of pyelonephritis OR complicating factors present?
Yes
Urine culture
Urine, Lab one time
  Decision to admit vs. discharge

Discharge criteria

  • Reassuring vital signs
  • Tolerating PO
  • Well-appearing
  • No social/family concerns
  • Reliable follow up in 24 hours
  • Patient/caregivers comfortable and understand discharge plan
  • Provider comfortable with outpatient therapy
  Patient to be admitted
  Does the patient have a cephalosporin allergy?
Yes
Gentamicin IV
5 mg/kg, IV, Every 24 hours
No
Ceftriaxone IV
50 mg/kg, IV, Every 24 hours, Max 1 g
  Patient to be discharged WITH symptoms of pyelonephritis

Symptoms of pyelonephritis: Fevers, chills, flank pain, costovertebral angle (CVA) tenderness, and nausea or vomiting

  Does the patient have a cephalosporin allergy?
Yes
Trimethoprim-sulfamethoxazole (co-trimoxazole) suspension
6 TMP/kg, PO, Once, (max 160 mg)
Trimethoprim-sulfamethoxazole (co-trimoxazole) double strength tablet [160/800 mg]
1 tab, PO, Once
No
Ceftriaxone IV
50 mg/kg, IV, Once, (max 1 g)
  Patient to be discharged WITHOUT symptoms of pyelonephritis

Symptoms of pyelonephritis: Fevers, chills, flank pain, costovertebral angle (CVA) tenderness, and nausea or vomiting

  Is the patient > 6 years old?
Yes
Phenazopyridine (Azo, Pyridium) tab
1 tab, PO, Once
  Is the patient > 11 years old?
Yes
Nitrofurantoin monohydrate / macrocrystals 100 mg tab
1 tab, PO, Once
No
Cephalexin suspension
25 mg/kg, PO, Once, (max 500mg)
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