NICE guide hinders childhood UTI care

NICE childhood UTI guidelines will hinder GPs' attempts to diagnose UTIs, according to a leading consultant paediatric nephrologist.

Writing in the journal Archives of Disease in Childhood, Dr Malcolm Coulthard from the Royal Victoria Infirmary in Newcastle-upon-Tyne said that GPs were failing to diagnose at least three quarters of UTIs in infants.

'If most GPs continue only to recognise a quarter of infant UTIs, there is little chance of reducing scarring rates which can lead to reflux nephropathy,' said Dr Coulthard.

'NICE advice about which infants to investigate could have the unintended result of reducing the diagnosis rate further.'

Dr Coulthard believes that NICE should not be advocating the use of nitrite testing of urine as a diagnostic screen as it has a low sensitivity and would 'guarantee that half of all children with a UTI would be missed'.

To improve awareness and treatment of UTIs, GPs need to be supported by a specialist nurse service, Dr Coulthard said.

His own study results backed this conclusion, he added.

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