Aside from the common cold and stomach bug, parents should add the term urinary tract infections (UTIs) to their shortlist of worrisome common illness, especially if they have daughters. To effectively treat urinary tract infections, pediatricians need accurate diagnosis and tailored therapy. Unfortunately, this information is often lacking. A recent survey of how healthcare providers diagnose and treat urinary infections in children, published in the journal Pediatrics, found that pediatricians, family doctors, and nurse practitioners treating children frequently do not order the necessary tests needed for accurate diagnosis and treatment. Experts recommend a course of antibiotics to treat a UTI, only after the child’s urine has been analysed and cultured. As it turns out, appropriate laboratory confirmation is only being done in about 50% of the time when various outpatient settings were analyzed. Antibiotics were being prescribed without knowing for sure that a child had a urinary tract infection. Amazing.
The California-based team of researchers stated, “this is the first large-scale study in children evaluating practice patterns surrounding urine testing in antibiotic-treated UTIs.” The team surveyed children (all less than 18 years old) who had an outpatient UTI and were prescribed antibiotics to treat the infection. The research team ultimately found that only 32% of children less than two years age had received outpatient urine culture testing. For children under 18 years of age, only 57% had urine cultures for diagnosis. The conclusions are clear; many providers are prescribing antibiotics to children without confirming their diagnosis of a urinary infection via urinalysis and urine culture.
Why all the concern? Well, there are multiple reasons that are addressed by this study. Firstly, it appears as if healthcare providers are not following established guidelines of experts who recommend urine testing to diagnose urinary infections. Secondly, it is likely that antibiotics are being over prescribed to children with urinary symptoms. This possible over use of antibiotics contributes to the rise in antibiotic microbial resistance, a growing threat to everyone’s health. Presently, drug researchers are struggling to keep pace with increasingly antibiotic resistant bacteria. Finally, the judicious us of antibiotics, aided by laboratory testing, remains critical if we are to maintain antibiotic the effectiveness of the antibiotics we currently have. The conclusion is clear– practitioners need to only use antibiotics when they know they are clearly needed. All in all, this study reminds this pediatrician of the ageless wisdom of Hippocrates, “Doctor, do no harm”. Accurate diagnosis of UTI’s let’s pediatricians fulfill this ancient mandate they have sworn to uphold.
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Written collaboratively by Norman Spencer and Paul Smolen M.D.