Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 Apr;65(633):e217-23.
doi: 10.3399/bjgp15X684361.

Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

Christopher C Butler  1 , Kathryn O'Brien  2 , Timothy Pickles  3 , Kerenza Hood  3 , Mandy Wootton  4 , Robin Howe  4 , Cherry-Ann Waldron  3 , Emma Thomas-Jones  3 , William Hollingworth  5 , Paul Little  6 , Judith Van Der Voort  7 , Jan Dudley  8 , Kate Rumsby  6 , Harriet Downing  9 , Kim Harman  9 , Alastair D Hay  9 ; DUTY study team
Affiliations
Observational Study

Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery

Christopher C Butler et al. Br J Gen Pract. 2015 Apr.

Abstract

Background: The prevalence of targeted and serendipitous treatment for, and associated recovery from, urinary tract infection (UTI) in pre-school children is unknown.

Aim: To determine the frequency and suspicion of UTI in children who are acutely ill, along with details of antibiotic prescribing, its appropriateness, and whether that appropriateness impacted on symptom improvement and recovery.

Design and setting: Prospective observational cohort study in primary care sites in urban and rural areas in England and Wales.

Method: Systematic urine sampling from children aged <5 years presenting in primary care with acute illness with culture in NHS laboratories.

Results: Of 6079 children's urine samples, 339 (5.6%) met laboratory criteria for UTI and 162 (47.9%) were prescribed antibiotics at the initial consultation. In total, 576/7101 (8.1%) children were suspected of having a UTI prior to urine sampling, including 107 of the 338 with a UTI (clinician sensitivity 31.7%). Children with a laboratory-diagnosed UTI were more likely to be prescribed antibiotics when UTI was clinically suspected than when it was not (86.0% versus 30.3%, P<0.001). Of 231 children with unsuspected UTI, 70 (30.3%) received serendipitous antibiotics (that is, antibiotics prescribed for a different reason). Overall, 176 (52.1%) children with confirmed UTI did not receive any initial antibiotic. Organism sensitivity to the prescribed antibiotic was higher when UTI was suspected than when treated serendipitously (77.1% versus 26.0%; P<0.001). Children with UTI prescribed appropriate antibiotics at the initial consultation improved a little sooner than those with a UTI who were not prescribed appropriate antibiotics initially (3.5 days versus 4.0 days; P = 0.005).

Conclusion: Over half of children with UTI on culture were not prescribed antibiotics at first presentation. Serendipitous UTI treatment was relatively common, but often inappropriate to the organism's sensitivity. Methods for improved targeting of antibiotic treatment in children who are acutely unwell are urgently needed.

Keywords: antibacterial agents; child; diagnosis; primary health care; urinary tract infections.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart of study process.
Figure 2.
Figure 2.
Days from initial consultation until symptoms improved, by prescription/ non-prescription of antibiotics.
Figure 3.
Figure 3.
Days from initial consultation until full recovery, by prescription/non-prescription of antibiotics.
See this image and copyright information in PMC

Comment in

References

    1. Van der Voort J, Edwards A, Roberts R, Verrier Jones K. The struggle to diagnose UTI in children under two in primary care. Fam Pract. 1997;14(1):44–48. - PubMed
    1. Coulthard MG, Vernon SJ, Lambert HJ, Matthews JN. A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial. BMJ. 2003;327(7416):656. - PMC - PubMed
    1. O’Brien K, Edwards A, Hood K, Butler CC. Prevalence of urinary tract infection in acutely unwell children in general practice: a prospective study with systematic urine sampling. Br J Gen Pract. 2013 doi: 10.3399/bjgp13X663127. - DOI - PMC - PubMed
    1. National Institute for Health and Care Excellence Urinary tract infection in children: diagnosis, treatment and long-term management. 2007. Clinical guideline 54. http://guidance.nice.org.uk/CG054 (accessed 26 Jan 2015) - PubMed
    1. Coulthard MG, Lambert HJ, Vernon SJ, et al. Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Arch Dis Child. 2013;99(4):342–347. - PMC - PubMed

Publication types

MeSH terms

Substances