Uncomplicated Urinary Tract Infection (UTI) in Ambulatory Primary Care Pediatrics. Are We Using Antibiotics Appropriately?

Al-Sayyed, Ban; Le, Jeremy; Al-Tabbaa, Mohammad Mousbah; Barnacle, Brian; Ren, Jinma; Aiyer, Meenakshy; Tapping, Richard I.

doi:10.1093/ofid/ofx163.1309

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“…The use of broad spectrum antibiotic prescriptions in our study was high, and most prescriptions for cystitis were not in accordance with the Belgian clinical guidelines. These findings are comparable to data obtained in other primary care studies, showing 26-34% inadequate use of antibiotic treatment in children with UTI [ 10 , 24 , 25 , 27 ]. Data from Sciensano, the Belgian Scientific Institute of Public Health, show very high resistance of urinary Escherichia Coli to amoxicillin (52%) in 2020 [2017: 51%, 2018: 53%, 2019: 50%]; and to amoxicillin clavulanic acid (43%) in 2020 [2017: 16%, 2018: 45%, 2019: 44%], in outpatient children < 5 years old.…”

Section: Discussionsupporting

confidence: 89%

Incidence rates and trends of childhood urinary tract infections and antibiotic prescribing: registry-based study in general practices (2000 to 2020)

et al. 2022

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Background To improve the management of childhood urinary tract infections, it is essential to understand the incidence rates, testing and treatment strategy. Methods A retrospective study using data from 45 to 104 general practices (2000 to 2020) in Flanders (Belgium). We calculated the incidence rates (per 1000 person-years) of cystitis, pyelonephritis, and lab-based urine tests per age (< 2, 2-4, 5-9 and 10-18 years)) and gender in children and performed an autoregressive time-series analysis and seasonality analysis. In children with UTI, we calculated the number of lab-based urine tests and antibiotic prescriptions per person-year and performed an autoregressive time-series analysis. Results There was a statistically significant increase in the number of UTI episodes from 2000 to 2020 in each age group (p < 0.05), except in boys 2-4 years. Overall, the change in incidence rate was low. In 2020, the incidence rates of cystitis were highest in girls 2-4 years old (40.3 /1000 person-years 95%CI 34.5-46.7) and lowest in boys 10-18 (2.6 /1000 person-years 95%CI 1.8-3.6) The incidence rates of pyelonephritis were highest in girls 2-4 years (5.5, 95%CI 3.5-8.1 /1000 person-years) and children < 2 years of age (boys: 5.4, 95%CI 3.1-8.8 and girls: 4.9, 95%CI 2.7-8.8 /1000 person-years). In children 2-10 years, there was an increase in number of lab-based urine tests per cystitis episode per year and a decrease in total number of electronic antibiotic prescriptions per cystitis episode per year, from 2000 to 2020. In children with cystitis < 10 years in 2020, 51% (95%CI 47-56%) received an electronic antibiotic prescription, of which the majority were broad-spectrum agents. Conclusions Over the last 21 years, there was a slight increase in the number of UTI episodes diagnosed in children in Flemish general practices, although the overall change was low. More targeted antibiotic therapy for cystitis in accordance with clinical guidelines is necessary to reduce the use of broad-spectrum agents in children below 10 years.

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