Clinical Practice Guideline

In The Approach And Treatment

Of Urinary Tract Infection In Children
In The Philippine Setting

Ma. Leilani B. Gonzales M.D.

VMMC-Pediatrics
Objective
• Develop a guideline on the approach on
urinary tract infection in children in Philippines
based on available accepted evidence

Target Population
• Children below 18 years of age
Method
1. Development of conceptual evidence-based
model
2. Development of a decision tree based on the
evidence available
3. Comprehensive review of available data
(local and international)
4. Algorithm based on cost-benefit
 Model
Suspect
Probability of UTI
Diagnosis of UTI
Treatment
Work-up
long-term follow-up
 Categories
Strength of each recommendation for or against its use
Category Definition
A Good evidence to support a recommendation for use
B Moderate evidence to support a recommendation for
use
C Poor evidence to support a recommendation against use
D Moderate evidence to support a recommendation
against use
E Good evidence to support a recommendation against
use
Quality of evidence on which recommendations are based

Grade Definition
I Evidence from at least one properly randomized,
controlled trial
II Evidence from at least one well designed in trial without
randomization; from cohort or case-controlled analytical
studies: uncontrolled experiments
III Evidence from opinion of respected authorities, based on
clinical experience, descriptive studies, or reports of
expert committies
 Child with Probable UTI
I. The SUSPECT
1. The neonates presenting with signs and
symptoms presented in table 1.
2. Febrile infants (>38 C) below 2 years of age.
3. Older children manifesting symptoms
referable to urinary tract

Recommendation A/II
 Signs/Symptoms Neonates Older Infants School Age Adolescents
Septic
Temperature instability
Poor feeding
Vomiting
Lethargy or irritability
Jaundice
Fever
Poor weight gain/failure to thrive
Diarrhea
Abdominal pain
Frequency, dribbling, urgency dysuria
Weak urinary stream
Malodorous urine
Enuresis
 Signs/Symptoms Neonates Older Infants School Age Adolescents
Septic +
Temperature instability +
Poor feeding +
Vomiting + +
Lethargy or irritability +
Jaundice +
Fever + + +
Poor weight gain/failure to thrive + + +
Diarrhea + +
Abdominal pain + +
Frequency, dribbling, urgency dysuria + + +
Weak urinary stream + +
Malodorous urine +
Enuresis
Flank pains