Lower urinary tract infection in a child — MRCEM SBA MCQ

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EasyPaediatric emergenciesLower urinary tract infection in a childMRCEM SBA

A 5-year-old girl presents to the emergency department with one day of dysuria and urinary frequency. She has had no fever, vomiting or loin pain. She is alert, well hydrated and able to take oral medication. A freshly voided clean-catch urine sample is tested immediately: nitrite is positive and leukocyte esterase is negative. What is the most appropriate management now?

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Correct answer: E — Send urine for culture and start oral antibiotics now.

This child’s dysuria and frequency support a urinary tract infection. The absence of fever, loin pain or other systemic features favours a lower UTI, and she can take oral treatment. For children aged 3 years or older, NICE distinguishes a nitrite-positive, leukocyte-esterase-negative result from a wholly negative dipstick. **When the tested sample is fresh**, its recommended strategy is to give antibiotics and send urine for culture; subsequent management depends on the culture result. NICE also recommends an immediate antibiotic prescription for children with lower UTI. ([nice.org.uk](https://www.nice.org.uk/guidance/ng224/chapter/Recommendations)) A delays treatment despite a qualifying positive nitrite result. B treats promptly but misses the culture specifically required for this dipstick combination. C wrongly requires both dipstick markers to become positive; repeating this promptly tested sample adds no useful prerequisite. D makes microscopy a barrier to treatment even though the fresh-sample dipstick result already directs the initial decision. The culture should be obtained before the first antibiotic dose, with treatment started now rather than delayed for laboratory confirmation. ([nice.org.uk](https://www.nice.org.uk/guidance/ng224/chapter/Recommendations))

Reference: Urinary tract infection in under 16s: diagnosis and management, recommendations 1.1.20–1.1.21 and 1.1.25–1.1.26 (27 July 2022) — https://www.nice.org.uk/guidance/ng224/chapter/Recommendations Urinary tract infection (lower): antimicrobial prescribing, recommendations 1.1.9–1.1.11 (31 October 2018) — https://www.nice.org.uk/guidance/ng109/chapter/Recommendations