Current primary care management of children aged 1-36 months with urinary tract infections in Europe: large scale survey of paediatric practice.
OBJECTIVE
To describe current practice among European paediatricians regarding diagnosis and management of urinary tract infections in children aged 1-36 months and to compare these practices with recently published guidelines.


METHODS
Web-based large scale survey evaluating knowledge of, attitudes towards and the methods for diagnosing, treating and managing urinary tract infections in children.


METHODS
Primary and secondary care practices in Europe.


METHODS
1129 paediatricians.


RESULTS
A diagnosis of urinary tract infection is considered by 62% of the respondents in children aged 1-36 months with unexplained fever. The preferred method of urine collection is use of a bag (53% for infants <3 months and 59% for children 4-36 months of age). 60% of paediatricians agree that oral and parenteral antibiotics have equal efficacy. Co-amoxiclav is the antibiotic of choice for 41% of participants, while 9% prescribe amoxicillin. 80% of respondents prescribe ultrasound in all children with a confirmed urinary tract infection. 63% of respondents prescribe a cystography when abnormalities are revealed during ultrasound evaluation. A quarter of respondents recommend antibiotic prophylaxis for all children with any vesicoureteral reflux. The data among European countries are very heterogeneous. The three most recent urinary tract infection guidelines (the National Institute for Health and Care Excellence (NICE), the American Academy of Paediatrics and the Italian Society of Paediatric Nephrology) are not followed properly.


CONCLUSIONS
Management of febrile urinary tract infections remains controversial and heterogeneous in Europe. Simple, short, practical and easy-to-remember guidelines and educational strategies to ensure their implementation should be developed.
Faculty of Medicine, European University Cyprus, Larnaca General Hospital, Derynia, Cyprus.
Adamos
A
Hadjipanayis
Pediatric Clinic, Maccabi Health Services, Tel Aviv, Israel.
Zachi
Z
Grossman
Pediatra di Famiglia ULSS 16, Studio Pediatrico Vecellio 33, Padova, Italy.
Stefano
S
Del Torso
Primary Care Health Centre 'Pare Claret', Catalan Institute of Health, Barcelona, Spain.
Diego
D
van Esso
Grazerstrasse 34b, Graz, Austria.
Hans Juergen
HJ
Dornbusch
Medical Faculty, University of Rzeszów, Rzeszów, Poland.
Artur
A
Mazur
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Anna
A
Drabik
Nephrology and Dialysis Unit, Department of Paediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy.
Giovanni
G
Montini
D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005060:Europe; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011859:Radiography; D013048:Specimen Handling / Q000706:statistics & numerical data; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014556:Urine / Q000382:microbiology; D014718:Vesico-Ureteral Reflux / Q000517:prevention & control; D065093:beta-Lactamase Inhibitors / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D065093:beta-Lactamase Inhibitors; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin
General Paediatrics; Nephrology