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

Letter

Management of urinary tract infections in children

No evidence exists

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

EDITOR—Renal disease is serious, but it is peculiarly difficult to find direct evidence that it can be prevented by the systematic approach to possible urinary tract infection in young children advocated by Coulthard et al1.

Clinical Evidence identifies no relevant randomised controlled trials2 and one systematic review of descriptive studies that itself found no evidence of benefit3. The claim by Coulthard et al that Sweden's aggressive approach has reduced end stage renal failure is a bold conclusion to draw from small numbers in the epidemiological survey they cite4.

Another paper they offer as evidence of serious sequelae of urinary tract infection in children implies that such infections may not be the problem5.

Serious renal disease is comparatively rare4, whereas urinary tract infection in childhood is common. Even if effective, the number needed to screen to prevent one adverse outcome is likely to be . . . [Full text of this article]

Adam Sandell, general practitioner

Adelaide Medical Centre, Adelaide Terrace, Newcastle upon Tyne NE4 8BE adam.sandell@nhs.net


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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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