Abstract
Urinary tract infection (UTI) is a common bacterial infection of children, with a study published only 2 months ago showing the prevalence of UTI to be around 6% in preschool children presenting unwell to primary care.1 Accurate and timely diagnosis is important in children because appropriate treatment may alleviate suffering and help prevent long-term sequelae such as renal scarring, poor renal growth, recurrent pyelonephritis, impaired glomerular function, hypertension, end stage renal disease, and pre-eclampsia. There is evidence from NICE2 and our group3 regarding the children in whom UTI should be suspected, but much of the evidence was generated in secondary care. However, primary care generated evidence for the symptoms and signs of UTI in preschool children should be available by the end of 2013 from the Diagnosis of Urinary Tract infection in Young children (DUTY) study (see www.dutystudy.org.uk/). In terms of management, NICE recommends all children aged over 3 months with suspected cystitis/lower UTI receive 3 days of trimethoprim, nitrofurantoin, a cephalosporin, or amoxicillin (younger children, and any child with suspected pyelonephritis, should be immediately referred to secondary care).2 But which antibiotic should primary care clinicians use first? NICE says there is no evidence for differences in effectiveness and that the …
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