Children Given Antibiotics for UTIs Without Urine Testing

A substantial portion of children treated with antibiotics for urinary tract infections are not given a urine test first, according to the results of a new study.

New research suggests that pediatricians may often prescribe antibiotics for urinary tract infections (UTIs) without first obtaining urine tests, despite guidelines that suggest otherwise.

The American Academy of Pediatrics currently suggest that providers obtain a urinalysis or a urine culture for children aged 2 to 24 months before prescribing antibiotics for a UTI, and current guidelines from the National Institute for Health and Clinical Excellence recommend urine testing in children aged 3 to 36 months. Testing is recommended for infants and young children, as they cannot communicate and often present with symptoms associated with multiple conditions. Older children can communicate their symptoms more effectively; therefore, there are no guidelines for testing in children older than 3 years.

The study, published online on August 5, 2013, in Pediatrics, evaluated urine-testing trends in children younger than 18 years who were prescribed antibiotics for UTIs from 2002 to 2007. Using a large claims database, the researchers collected information on age, gender, diagnosis, and treatment. In order to see whether guidelines were followed by practitioners, children were divided into 4 age categories: younger than 2, 2 to 5, 6 to 12, and 13 to 17 years.

A total of 40,603 UTIs were treated with antibiotics in 28,678 children. Urinalysis was performed in 76% of these cases, urine culture in 57%, and either form of testing in approximately 80% of all cases. However, children younger than 2 years were the least likely to be tested of the age groups, with either form of testing being performed in just 68% of cases in this group. Boys and those who were treated by a urologist were also less likely to be tested. In addition, the researchers found that the portion of patients for whom urine cultures were obtained decreased from 60% at the beginning of the study to 54% at the end.

The results indicate that urine tests are not performed in a substantial percentage of UTI patients treated with antibiotics, especially young children who are at the greatest risk of incorrect diagnosis and treatment. The authors conclude that additional research is needed to determine whether urine tests should or should not be recommended in older children as well.