I would like to comment on this carefully performed study by Malcolm
Coulthard et al. The study showed how the authors succeeded in increasing
compliance among general practitioners with the 1991 RCP Guidelines on UTI
management in children. The study put particular emphasis on the imaging
investigations and an overwhelming number of children (610) had DMSA scans
which yielded only 15 with renal scars (the extent of which is not
provided and neither is their potential clinical significance). Another
measure of success used was the finding that around 90% or more of the
study children under 4 years were put on antibiotic prophylaxis. There has
been no study that has shown that children benefit from this practice.
I think it is a missed opportunity to devote precious resources to
achieve these outcome measures which have not been shown to improve the
well being of these children, over and above those such as identifying and
managing well established risk factors for UTIs such as constipation and
bladder instability and achieving the prompt recognition and treatment of
UTIs, an undisputed factor in the limitation or even prevention of
potential renal scarring which the study group failed to achieve.
The time is ripe for a revision of the imaging guidelines in the RCP
recommendations moving away from their blankett approach in a way that
their yield of significant abnormalities is increased.
Rapid Response:
Priorities in the management of UTI in children
Dear Sir/Madam
I would like to comment on this carefully performed study by Malcolm
Coulthard et al. The study showed how the authors succeeded in increasing
compliance among general practitioners with the 1991 RCP Guidelines on UTI
management in children. The study put particular emphasis on the imaging
investigations and an overwhelming number of children (610) had DMSA scans
which yielded only 15 with renal scars (the extent of which is not
provided and neither is their potential clinical significance). Another
measure of success used was the finding that around 90% or more of the
study children under 4 years were put on antibiotic prophylaxis. There has
been no study that has shown that children benefit from this practice.
I think it is a missed opportunity to devote precious resources to
achieve these outcome measures which have not been shown to improve the
well being of these children, over and above those such as identifying and
managing well established risk factors for UTIs such as constipation and
bladder instability and achieving the prompt recognition and treatment of
UTIs, an undisputed factor in the limitation or even prevention of
potential renal scarring which the study group failed to achieve.
The time is ripe for a revision of the imaging guidelines in the RCP
recommendations moving away from their blankett approach in a way that
their yield of significant abnormalities is increased.
Dr Lyda P Jadresic
Consultant Paediatrician
Gloucestershire Royal Hospital
Competing interests:
None declared
Competing interests: No competing interests