MANAGEMENT OF FEBRILE CHILDREN WITH URINARY-TRACT INFECTIONS

This study of the management of children with fever and urinary tract infection (UTI) was conducted to identify factors associated with init ial admission, outpatient treatment, and outpatient treatment failure. A retrospective chart review identified children 3 months to 16 years of age with an emergency department (ED) diagnosis of cystitis, pyelo nephritis, or UTI, a positive urine culture, and an ED temperature of >38 degrees C. Sixty-nine patients (90% female) were studied; 19% were admitted initially Age younger than 2 years was associated with admis sion (P < .001), Of those initially discharged, 63% received parentera l antibiotics (usually intramuscular ceftriaxone), followed by oral an tibiotics; 9% failed outpatient treatment. Outpatient failure was asso ciated with higher initial temperatures (median 40.1 degrees C v 39.2 degrees C, P = .03, Mann-Whitney U) but was unrelated to age, initial white blood cell count, or use of parenteral antibiotics. These result s indicate that most children with fever and UTI do not require hospit al admission; those with temperatures of greater than or equal to 40 d egrees C are at increased risk for outpatient failure. Copyright (C) 1 998 by W.B. Saunders Company.