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GPs buried under trusts' workload dump

NICE guidance on UTI branded 'bizarre'

GPs risk missing large numbers of childhood UTIs because of potentially ‘disastrous' recommendations included in NICE guidance, experts are warning.

The institute's guidelines on childhood UTI have been branded ‘bizarre' by urology specialists, including some of those involved in drawing them up.

Dr Malcolm Coulthard, consultant paediatric nephrologist at Royal Victoria Infirmary in Newcastle, was on the guideline external review group and feels his views were ignored.

The recommendation that a UTI should be ruled out if children test negative for both leukocyte and nitrate dipstick testing was a ‘disaster', he said.

‘If you rely on dipstick testing then you will inevitably disregard 50% of patients.'

He argued that missed infections could cause serious kidney complications later in life, and that GPs should use microscopy testing even after negative dipstick tests.

Dr Steven Kane-ToddHall, a GP in Redcar, Teesside, and former renal lead for Langbaurgh PCT, said the NICE guidelines were helpful in some areas, but ‘bizarre' and ‘unclear' in others. He criticised the dipstick guidance, adding: ‘If it was appropriate, I would send off a sample.'

Dr James Larcombe, a GP in Sedgefield, Teesside, and a member of the NICE guideline committee, said there was ‘good reason' to be concerned about the way the guidelines were formed.

But he added that dipstick testing was quick and relatively sensitive – although he admitted that missed diagnoses could ‘store up some resentment against the guideline'.

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