TY - JOUR T1 - Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery JF - British Journal of General Practice JO - Br J Gen Pract SP - e217 LP - e223 DO - 10.3399/bjgp15X684361 VL - 65 IS - 633 AU - Christopher C Butler AU - Kathryn O’Brien AU - Timothy Pickles AU - Kerenza Hood AU - Mandy Wootton AU - Robin Howe AU - Cherry-Ann Waldron AU - Emma Thomas-Jones AU - William Hollingworth AU - Paul Little AU - Judith Van Der Voort AU - Jan Dudley AU - Kate Rumsby AU - Harriet Downing AU - Kim Harman AU - Alastair D Hay A2 - , Y1 - 2015/04/01 UR - http://bjgp.org/content/65/633/e217.abstract N2 - 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 <5years 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. ER -