Antibiotics often prescribed for UTIs without urine testing

Physicians often empirically prescribe antibiotics for urinary tract infections (UTIs) without conducting urine testing (urinalysis or culture), according to a retrospective study of 40,603 treated UTI episodes in youngsters aged up to 18 years. Analysis of data from a large claims database for 2002 through 2007 also showed that urine culture use varied considerably among different groups of patients and physicians and that factors that place a patient at increased risk for resistant UTI were not strongly associated with urine culture use.

Of total antibiotic-treated UTI episodes, urinalysis was performed in 76% and urine culture in 57%. In fact, urine culture use decreased during the study period, from 60% to 54%, and 32% of children aged younger than 2 years had no urinalysis or culture performed for an antibiotic-treated UTI. (Broad-spectrum antibiotics were prescribed in 29% of total antibiotic-treated episodes.) Urine cultures were most likely to be used when the treating physician specialized in emergency medicine or pediatrics (rather than being a family physician/internist), and the patient recently was exposed to an antibiotic or received a broad-spectrum antibiotic prescription.

Likelihood of urine culture varied by age, with children younger than 2 years and older than 12 years being 30% less likely than 2- to 12- year-olds to be cultured. Children were less likely to have urine cultures performed if they were male, treated by a urologist, lived in the Northeast or West, or had been hospitalized within the past 30 days. A previous UTI, urologic anomalies, and nonurologic comorbidities were not associated with urine culture use (Copp HL, et al. Pediatrics. 2013;132[3]:437-444).

COMMENTARY  I suspect that children aged younger than 2 years are less likely to be cultured because collecting urine is most difficult in that age group. Still, I am surprised that 32% of children that age had no testing at all. In an age group where symptoms of UTI are so nonspecific, I would want to have some evidence of the infection before committing the child to treatment. -MICHAEL BURKE, MD

MS FREEDMAN is a freelance medical editor and writer in New Jersey. DR BURKE, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. He is a contributing editor for Contemporary Pediatrics. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.