(精选)NSMC中得抗生素处方Antibiotic prescribing at NSMC教学课件.pptVIP

Key messages: Treating symptomatic acute urinary tract infection in children with an antibiotic is accepted clinical practice and trials would be considered unethical We found little evidence on the effects of delaying treatment while awaiting microscopy or culture results, but retrospective observational studies suggest delayed treatment may be associated with increased rates of renal scarring One systematic review of randomised controlled trials (RCTs) has found that antibiotic treatment for seven days or longer is more effective than shorter courses We found no convincing evidence of benefit from routine diagnostic imaging of all children with a first urinary tract infection, but subgroups at increased risk of future morbidity may benefit from investigation. Because such children cannot currently be identified clinically, investigating all young children with urinary tract infection may be warranted Two small RCTs found that prophylactic antibiotics prevented recurrent urinary tract infection in children, particularly during the period of prophylaxis. The long term benefits of prophylaxis have not been adequately evaluated, even for children with vesicoureteric reflux. The optimum duration of treatment is unknown One systematic review and a subsequent multicentre RCT found no difference between surgery for vesicoureteric reflux and medical management in preventing recurrence or complications from UTI Practice at NSMC 33 cases of Hx entry UTI over 3 years Age range 1year – 14years Symptoms including abdo pain, dysuria, frequency, vomiting, fever, wetting 15% no symptoms recorded 72% urine dip recorded, 7 did not, 2 noted not possible All those with urine dip reported positive Prescribing for UTINSMC Of all positive dips all but 2 had ABX immediately 2 positive dips awaited MSU before Rx Where dip not possible 2 awaited MSU before Rx 17 had Trimethoprim, 9 Amox/Amp, 1 Cipro Length of Rx ranged from 3 – 10days (Trimethoprim 10 days, Amp 5 days) MSU 63%