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

Urinary tract infections (UTIs) in young children should be diagnosed using urine samples collected before antibiotics are given. The preferred method is a clean catch method where possible. If this is not feasible, other non-invasive methods such as urine collection pads can be used, following manufacturer instructions. When non-invasive methods are impractical, catheter samples or suprapubic aspiration (SPA) with ultrasound guidance should be considered.

Urine samples should be tested with dipstick testing for children aged 3 months to 3 years. If both leukocyte esterase and nitrite are negative, antibiotics are not indicated, and further testing is usually unnecessary unless specific criteria are met. If either is positive, the sample should be sent for culture, and antibiotics should be given.

For children aged 3 years or older, urine dipstick testing results guide management: if both leukocyte esterase and nitrite are positive, assume UTI and start antibiotics; if only one is positive, send for culture and consider clinical signs before prescribing. Interpretation of microscopy results and clinical assessment are also important for diagnosis.

Management includes prompt antibiotic treatment, with choices depending on age and risk factors. For infants under 3 months or suspected upper UTI, urgent referral to paediatric specialists is recommended. Ultrasound imaging is advised during or after infection to identify structural abnormalities, especially in recurrent or atypical cases.