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NICE advice on child UTI

NICE has published draft guidance on diagnosis and treatment of urinary tract infection in young children.

The recommendations include an algorithm detailing use of dipstick tests and urine culture, and when to initiate antibiotic treatment (see below).

The advice, out for consultation until December, includes when to do a urine test in young children who cannot communicate their symptoms.

But it also states that in an acutely unwell child treatment should not be delayed if a urine sample is unobtainable.

Dr James Larcombe, a GP in Sedgefield, County Durham, and member of the guideline development group, said: 'I think the algorithm scale will have a very great bearing for GPs.'

He added: 'It's very difficult to tell one individual apart from another at such a young age, in terms of whether they will have long-term risk factors from kidney disease or UTI without long-term complications.'

But Dr Anthony Harnden,lecturer and principal in general practice at the University of Oxford, said the guidelines did not address all of the key problems in UTI care.

'I welcome the algorithm for the most appropriate investigations. But the greatest challenge is collecting a clean urine sample in very young infants.'

Diagnosis and treatment of UTI

• In children under three, do urine culture test but don't wait for results to initiate treatment if acutely-ill.

• In children older than three, carry out urine dipstick test – initiate antibiotic treatment if nitrite and LE positive or nitrite positive and LE negative.

• In systemically well children treat with three-day course of antibiotics.

• If still unwell after 24-48 hours reassess with urine culture to identify antibiotic sensitivity if an alternative diagnosis is not made.

• Refer severely-ill children to secondary care.

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