Antibiotic prophylaxis for childhood urinary tract infection: a national survey.
OBJECTIVE
To describe attitudes of paediatricians and paediatric nephrologists regarding antibiotic prophylaxis for urinary tract infection (UTI) and determine the factors associated with its use.


METHODS
A self-administered questionnaire was mailed to Canadian paediatricians (1136) and paediatric nephrologists (42).


RESULTS
The response rate was 58.1% (684 physicians); 436 who had made a decision about antibiotic prophylaxis for childhood UTI in the previous year were included in the analysis. Of these, 407 (93.3%) were certified in paediatrics and 29 (6.7%) were paediatric nephrologists. Most respondents prescribed prophylaxis for children with grade III-V vesicoureteral reflux (VUR) (96.5%-98%); 69.8 and 92.8% prescribed it for children with grades I and II VUR, respectively. Factors significantly associated with use of prophylaxis for children with grade I VUR were frequency of decision-making about prophylaxis, city size and province. Fifteen percent of physicians felt that their practice regarding antibiotic prophylaxis for children with VUR was evidence based. A hundred one respondents (24.3%) prescribed prophylaxis for infants with a first febrile UTI in the absence of VUR. Nineteen percent felt that their practice regarding antibiotic prophylaxis for these infants was evidence based. Prescription of prophylaxis for children >12 months with recurrent UTI in the absence of VUR was influenced by frequency of pyelonephritis (88.5% of respondents) and presence of voiding dysfunction (53.8%). Nine percent of physicians felt that their practice for these children was evidence based.


CONCLUSIONS
Opinions of Canadian paediatricians and paediatric nephrologists regarding antibiotic prophylaxis for UTI in children vary widely, probably because of the paucity of solid evidence about prophylaxis.
Chevalier
Isabelle
I
Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. isabelle.chevalier.hsj@ssss.gouv.qc.ca
Benoît
Geneviève
G
Gauthier
Marie
M
Phan
Véronique
V
Bonnin
Anne-Claude Bernard
AC
Lebel
Marc H
MH
D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009582:Nitrofurantoin / Q000627:therapeutic use; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D000892:Anti-Infective Agents, Urinary; D000658:Amoxicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin