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Current primary care management of children aged 1–36 months with urinary tract infections in Europe: large scale survey of paediatric practice
  1. Adamos Hadjipanayis1,
  2. Zachi Grossman2,
  3. Stefano del Torso3,
  4. Diego van Esso4,
  5. Hans Juergen Dornbusch5,
  6. Artur Mazur6,
  7. Anna Drabik7,
  8. Giovanni Montini8
  1. 1Faculty of Medicine, European University Cyprus, Larnaca General Hospital, Derynia, Cyprus
  2. 2Pediatric Clinic, Maccabi Health Services, Tel Aviv, Israel
  3. 3Pediatra di Famiglia ULSS 16, Studio Pediatrico Vecellio 33, Padova, Italy
  4. 4Primary Care Health Centre ‘Pare Claret’, Catalan Institute of Health, Barcelona, Spain
  5. 5Grazerstrasse 34b, Graz, Austria
  6. 6Medical Faculty, University of Rzeszów, Rzeszów, Poland
  7. 7Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  8. 8Nephrology and Dialysis Unit, Department of Paediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy
  1. Correspondence to Dr Giovanni Montini, Nephrology, Dialysis Unit, Department of Paediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi Bologna, Via Massarenti 11, Bologna 40138, Italy; giovanni.montini{at}


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.

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

Setting Primary and secondary care practices in Europe.

Sample 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.

  • Nephrology
  • General Paediatrics

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