Cefalexin for UTIs – Right treatment Length in Young children

Eligibility

Local study conflicts

• Cannot enrol if patient is on any other drug trial

Inclusion Criteria: (all criteria must apply)

1. Age 3 months to 11 years inclusive
2. Clinical diagnosis of febrile UTI at presentation to ED as defined by BOTH:
• Temperature ≥38°C measured by any method or likely fever in the last 24 hours
• Clinical feature(s) suggestive of UTI at presentation – at least one symptom:

Under two years old:
Poor feeding
Vomiting
Irritability

Over two years old:
Vomiting
Dysuria
Urinary frequency
Urinary urgency
Abdominal or flank pain
Suprapubic or flank tenderness

3. Early urine test suggesting likely UTI as defined by any one of the following:
   
   1. Dipstick: nitrite positive AND leucocyte esterase positive.
   2. Dipstick: nitrite positive AND leucocyte esterase negative (on a fresh urine sample).
   3. Dipstick: leucocyte esterase positive AND nitrite negative AND the treating clinician assesses there to be good clinical evidence of a UTI (e.g. obvious urinary symptoms).
   4. Abnormal urine microscopy (bacteriuria by microscopy with Gram stain)
4. Decision to treat with oral cefalexin
5. Plan for discharge from the ED
6. Able to give written informed consent and use the App

Exclusion Criteria:

• Known congenital anomalies of the kidney and urinary tract (CAKUT), reflux nephropathy or indwelling catheter
• Known immune deficiency or currently receiving immunosuppression therapy
• Systemic antibiotics for any reason (treatment or prophylaxis) in the previous 14 days
• Weight > 50kg
• Known allergy to cefalexin or previous severe allergic reaction to any beta-lactam antibiotic
• The patient is on any other drug trial

If the patient is eligible:

Step by Step Guide to Recruitment:

In standard working hours; 9-5

• Please contact the ED Research Team when eligible patients arrive in ED:
  Send the ED Research Team a message via Epic chat "ED research Team" or phone 217907

Out of hours and weekends:

We are not planning to recruit OOH for the foreseeable future

Links for further information:

Link to local trial site
Link to patient information leaflet

Tap the button below to display a QR code link to the patient information leaflet:

QR code link

For local training to get on the delegation log, contact the ED Research Team to arrange access to the Birmingham TEAMs Channel