Urine dipstick

Urine testing strategies for Infants less than 3 months

All infants younger than 3 months with suspected UTI should be referred to paediatric specialist care and a urine sample should be sent for urgent microscopy and culture. These infants should be managed in accordance with the recommendations for this age group in Fever in under 5s [4]. Do not use a urine dipstick to guide management of possible UTI in this age group.

Urine-testing strategies for infants and children 3 months or older but younger than 3 years

Use dipstick testing for infants and children 3 months or older but younger than 3 years with suspected UTI [1].

Leukocyte Positive Leukocyte Negative
Nitrite Positive Start antibiotic, send urine culture Start antibiotic, send urine culture
Nitrite Negative Start antibiotic, send urine culture No antibiotic. Do not send urine culture (unless meets additional criteria)

Urine-testing strategies for children 3 years or older

Use dipstick testing for children over 3 years with suspected UTI [1].

Leukocyte Positive Leukocyte Negative
Nitrite Positive Treat as UTI

Send urine culture if high/intermediate risk of serious illness and/or history of previous UTI

Treat as UTI if fresh sample

Send urine culture

Nitrite Negative Only treat as UTI if good clinical evidence of such.

Send urine culture

NB May represent infection outside of urinary tract.

No UTI

Do not send urine culture

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