Diagnosis rests on clinical, and laboratory and culture criteria:
Clinical criteria: fever, irritability, decreased feeding, crying with micturition and if verbal, dysuria, urinary frequency, new incontinence, back or flank pain, malaise.
Laboratory criteria: positive nitrites and/or leukocyte esterase (LE) on urinalysis and/or pyuria (>5-10) on microscopy. If both LE and nitrites are negative, do not send a urine culture as low probability of a UTI. Blood culture should be done.
Culture criteria: ≥50 X 106 CFU/L of a single uropathogen such as E. coli, Klebsiella spp.. Amount less than this or mixed growth most likely indicates contamination.
If above criteria are not met, consider other diagnoses/explanations (e.g. sterile pyuria in inflammatory conditions).
Review criteria for diagnosis to prevent unnecessary prescribing.
Ensure clinical follow-up with a health care provider within 24-36 hours and to modify prescriptions according to culture results, if necessary.
In patients that will be discharged from ED
See Drug Monitoring section of cephalexin for information regarding sensitivity results
may add, depending on possibility of resistance
ALTERNATIVELY
Broader spectrum and can be associated with development of bacteria resistant to cephalosporins, consider if recent treatment with cephalexin
7 days of antibiotics to which the pathogen is susceptible.
Clinical response to antibiotics should be followed.