UTI Under 2 Years – Home or Hospital?

April 29, 2019

Written by Clay Smith

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Risk of repeat visit within 3 days with subsequent admission was not increased in children <2 years with UTI treated at home with oral antibiotics vs those initially admitted.

Why does this matter?
Hospital admission is costly and disruptive to life.  Would it be safe to treat children <2 years with oral antibiotics at home?

Should they stay or should they go?
This was a retrospective review of 36 hospitals, nearly 42,000 children with UTI, to determine the rate of 72h return visits for admission after children <2 years old were initially treated outpatient with oral antibiotics vs admission for IV antibiotics.  They found that 89% of children <2 months were admitted; just 15% from 2-24 months.  Those who were initially admitted were less likely to return for subsequent readmission.  There were more revisits to the ED in those initially treated as outpatients, but there was no difference in the rate of repeat visit with subsequent admission (-0.02, 95% CI -0.07 to 0.03).  There was wide variation in admission rate among hospitals.  In practice, I will probably admit <60 days.  Generally speaking, discharging most children with UTI on oral antibiotics appears to be safe, with no increase in rate of subsequent admission.

Source
Management of Urinary Tract Infections in Young Children: Balancing Admission With the Risk of Emergency Department Revisits.  Acad Pediatr. 2019 Mar;19(2):203-208. doi: 10.1016/j.acap.2018.05.011. Epub 2018 Jun 1.

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Reviewed by Thomas Davis