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Nasir Hamid
Professor Chris Butler (pictured).

Research highlighting an urgent need for improving how antibiotics are prescribed to pre-school children with urinary tract infections (UTI) has been recognised with a category prize at the recent RCGP Research Paper of the Year awards.

The observational study of over 7,000 acutely unwell children visiting their GP explores the notion that GPs may be underdiagnosing UTIs in children, and urges more suspicion of UTIs in the acutely unwell.

The study found that based on clinical grounds alone, GPs suspected a child had a UTI in less than one-third (31.7%) of cases that were later confirmed by laboratory tests of a urine sample.

The study, co-led by Professor Chris Butler in Oxford University’s Nuffield Department of Primary Care Health Sciences, was carried out by researchers at the Universities of Cardiff, Southampton, Bristol (with co-lead Prof Alistair Hay) and in Public Health Wales’ Specialist Antimicrobial Chemotherapy Unit, University Hospital of Wales and the Bristol Royal Hospital for Children.

Writing in the British Journal of General Practice in 2015, the authors suggest that “the problem of undiagnosing and untreating UTIs in children may have become more common in light of the reduced prescribing of antibiotics in children who are acutely unwell,” and point out that urine sampling rates are generally lower than recommended.

The study also revealed that participating GPs prescribe antibiotics serendipitously in around one-third (30.3%) of cases where the child’s UTI was later confirmed by laboratory testing, yet in only one quarter (26%) of those cases was this the correct antibiotic for their infection.

The authors recommend that GPs should become more aware of the possibility of UTIs in acutely unwell children and suggest that earlier recognition may be supported in the future through the use of a clinical algorithm. They suggest “this may increase the proportion of children with a UTI on culture who are prescribed an antibiotic at the first consultation, while avoiding antibiotics for children who do not have a UTI.”

The RCGP research paper of the year award is presented each year across six categories to recognise an individual or group of researchers who have undertaken and published an exceptional piece of research relating to general practice or primary care.

Professor Butler and Professor Alastair Hay, from the University of Bristol, were presented with their award at a special event on 28 September by Dr Imran Rafi, RCGP’s Chair of Clinical Innovation and Research.

In their related paper, published in the Annals of Family Medicine in July 2016, the same group of researchers describe a signs-and-symptoms clinical rule that GPs and nurses can use to select which children to collect a urine sample from.