BMJ  2003;327:1346 (6 December), doi:10.1136/bmj.327.7427.1346

Letter

Management of urinary tract infections in children

Priorities need to be set

The first 150 words of the full text of this article appear below.

EDITOR—Coulthard et al show how they succeeded in increasing compliance among general practitioners with the 1991 guidelines of the Royal College of Physicians on the management of urinary tract infections in children12. Their study particularly emphasised the imaging investigations. An overwhelming number of children (610) underwent scanning with dimercaptosuccinic acid, which yielded only 15 with renal scars (the extent and potential clinical significance of which are not described).

Another measure of success was the finding that 90% or more of the study children under 4 years old were given antibiotic prophylaxis. No study has shown that children benefit from this practice.

An opportunity was missed to devote precious resources to achieve these outcome measures (which have not been shown to improve the wellbeing of these children) above those such as identifying and managing well established risk factors for urinary tract infections (such as constipation and bladder instability) . . . [Full text of this article]

Lyda P Jadresic, consultant paediatrician

Gloucestershire Royal Hospital, Gloucester GL1 3NN Lyda.Jadresic@gloucr-tr.swest.nhs.uk


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Relevant Article

A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial
Malcolm G Coulthard, Sue J Vernon, Heather J Lambert, and John N S Matthews
BMJ 2003 327: 656. [Abstract] [Full Text] [PDF]

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