A survey of the management of urinary tract infection in children in primary care and comparison with the NICE guidelines

BMC Fam Pract. 2010 Jan 26;11:6. doi: 10.1186/1471-2296-11-6.

Abstract

Background: The aim of this study was to establish current practices amongst general practitioners in the West of Ireland with regard to the investigation, diagnosis and management of urinary tract infection (UTI) in children and to evaluate these practices against recently published guidelines from the National Institute for Health and Clinical Excellence (NICE).

Methods: A postal survey was performed using a questionnaire that included short clinical scenarios. All general practices in a single health region were sent a questionnaire, cover letter and SAE. Systematic postal and telephone contact was made with non-responders. The data was analysed using SPSS version 15.

Results: Sixty-nine general practitioners were included in the study and 50 (72%) responded to the questionnaire. All respondents agreed that it is important to consider diagnosis of UTI in all children with unexplained fever. Doctors accurately identified relevant risk factors for UTI in the majority (87%) of cases. In collecting urine samples from a one year old child, 80% of respondents recommended the use of a urine collection bag and the remaining 20% recommended collection of a clean catch sample. Respondents differed greatly in their practice with regard to detailed investigation and specialist referral after a first episode of UTI. Co-amoxiclav was the most frequently used antibiotic for the treatment of cystitis, with most doctors prescribing a five day course.

Conclusions: In general, this study reveals a high level of clinical knowledge amongst doctors treating children with UTI in primary care in the catchment area of County Mayo. However, it also demonstrates wide variation in practice with regard to detailed investigation and specialist referral. The common practice of prescribing long courses of antibiotics when treating lower urinary tract infection is at variance with NICE's recommendation of a three day course of antibiotics for cystitis in children over three months of age when there are no atypical features.

Publication types

  • Comparative Study

MeSH terms

  • Amoxicillin-Potassium Clavulanate Combination / therapeutic use
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Clinical Competence
  • Drug Administration Schedule
  • Family Practice / methods*
  • Family Practice / standards
  • Government Agencies / organization & administration
  • Guideline Adherence
  • Health Care Surveys
  • Humans
  • Patient Acceptance of Health Care
  • Physicians, Family / psychology
  • Physicians, Family / statistics & numerical data*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care / methods*
  • Primary Health Care / standards
  • Referral and Consultation
  • Risk Factors
  • Surveys and Questionnaires
  • Treatment Outcome
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / drug therapy*

Substances

  • Anti-Bacterial Agents
  • Amoxicillin-Potassium Clavulanate Combination