- Under 6/12, OPD USS sufficient if good response to treatment within 48 hours.
- Under 6/12 and atypical (see below) or recurrent (see below), then urgent USS to look for obstruction or severe reflux, or if simply non-E.coli then within 6 weeks. PLUS later OPD DMSA (ie 4-6 months post infection), MCUG.
- 6/12 to 3 yrs: nothing if good response to treatment within 48 hours. If atypical or recurrent, as above but no MCUG unless:
- family history,
- poor flow,
- dilated tract on US,
- non-E coli.
- Over 3yrs: nothing if good response to treatment within 48 hours. If atypical, only needs urgent USS (OPD USS within 6 weeks if simply non-E.coli). If recurrent, do OPD USS and later DMSA.
Atypical defined as seriously ill, poor urine flow, abdominal/bladder mass, raised creatinine, septicaemia, failure to respond to appropriate antibiotics within 48 hrs, non-E. coli infection
Recurrent defined as 3 lower tract UTIs, else 1 upper tract plus any other
If another UTI occurs before the DMSA is done, don’t defer DMSA in case scarring already established.
Prophylactic antibiotics for MCUG (1 day before to 1 day after).