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Suspected lower urinary tract infection in a child aged 3 years or older — MSRA MCQ

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ModerateUrinary Tract InfectionsSuspected lower urinary tract infection in a child aged 3 years or olderMSRA

A 7-year-old girl presents to general practice with 24 hours of dysuria, urinary frequency and new daytime urgency. She is drinking normally and has no vomiting, abdominal pain, loin pain, fever or previous UTI. She is alert, haemodynamically stable and appears well. Examination is unremarkable. A fresh clean-catch urine sample tested in the surgery is positive for leukocyte esterase and negative for nitrites. What is the most appropriate immediate management?

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Reveal the answer and explanation

Correct answer: B — Send the urine for microscopy and culture, and start an immediate oral antibiotic for lower urinary tract infection

Explanation lettering: D = shown as C · E = shown as D · C = shown as E

In a child aged 3 years or older, leukocyte esterase positive and nitrite negative urine should be sent for microscopy and culture. Antibiotics are not given solely on this dipstick pattern unless there is good clinical evidence of UTI. This child has clear lower urinary tract symptoms—dysuria, frequency and urgency—so immediate treatment for lower UTI is appropriate while culture confirms the diagnosis and susceptibility. A is incorrect because her symptom pattern provides sufficient clinical evidence to treat now; awaiting culture would delay treatment unnecessarily. C is incorrect because a positive leukocyte esterase result in this age group requires urine culture, even when empiric treatment is appropriate. D would be appropriate for isolated leukocyte esterase positivity without convincing urinary symptoms, when an alternative inflammatory or infective cause may be more likely. E is inappropriate because she is well, afebrile and has no loin pain, vomiting or systemic features to suggest upper UTI or sepsis.

Reference: Urinary tract infection in under 16s: diagnosis and management (NG224), recommendations 1.1.20–1.1.21 (Published 27 July 2022; minor update November 2025) — https://www.nice.org.uk/guidance/ng224/chapter/Recommendations Urinary tract infection (lower): antimicrobial prescribing (NG109), treatment for children and young people under 16 years (Published 31 October 2018) — https://www.nice.org.uk/guidance/ng109/chapter/recommendations