Author's reply

doi:10.1136/bmj.39325.451933.3A

BMJ 2007;335:463-464 (8 September), doi:10.1136/bmj.39325.451933.3A

Letters

NICE on childhood UTI

Author's reply

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

The guideline on urinary tract infection (UTI) in children fromthe National Institute for Health and Clinical Excellence (NICE)will precipitate debate, but hopefully cause less consternationthan that expressed by Coulthard (previous letter). The publishedclinical guideline runs to 150 pages and 271 references withmany systematic reviews.¹ We can all quote observational studiesthat don't pass the scrutiny of evidence based medicine, butperhaps we should remember that the 1991 Royal College of Physiciansguidelines were produced by 18 "experts" at a one day consensusmeeting with medical audit in mind. Achieving a further consensushas been difficult, with imaging modalities changing from intravenousurogram and micturating cystogram for all to ultrasound, radionuclideimaging, and more selective cystograms. At the same time, recognitionhas been increasing that a lot of what we called reflux nephropathyis reflux associated damage in association with congenital dysplasticand obstructive kidneys.