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 children1,2. 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) and achieving the prompt recognition and treatment of urinary tract infections. Prompt recognition and treatment are undisputed factors in limiting or even preventing potential renal scarring, which the study group did not achieve.
The imaging guidelines in the royal college's recommendations should move away from their blanket approach so that their yield of important abnormalities is increased.
Competing interests: None declared.
References
- 1.Coulthard MG, Vernon SJ, Lambert HJ, Matthews JNS. A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial. BMJ 2003;327: 656-9. (20 September.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Royal College of Physicians Research Unit Working Group. Guidelines for the management of acute urinary tract infection in childhood. J R Coll Physicians Lond 1991;25: 36-42. [PMC free article] [PubMed] [Google Scholar]