Guidelines
Outpatient UTI - Febrile

Outpatient UTI - Febrile

Clinical/Diagnostic Considerations

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 10 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).

Most Likely Pathogens

Empiric Antimicrobials

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

Usual Duration

7 days of antibiotics to which the pathogen is susceptible.

Clinical response to antibiotics should be followed.