Rationale and impact

Rationale and impact

This section summarises why the committee made the recommendations and how they might affect practice.

Urine testing

Why the committee made the 2017 recommendations

Evidence showed that a positive urine dipstick test for leukocyte esterase or nitrite in children 3 months or older but younger than 3 years greatly increases the likelihood of finding a positive urine culture. Sending only positive samples for culture offered a better balance of benefits and costs for these children than prescribing antibiotics and urine culture for all children. The committee agreed that there are concerns about sepsis in infants under 3 months with suspected UTI, and usual practice is referral rather than the GP managing symptoms. So the committee recommended that all children under 3 months should be referred to specialist paediatric care and have a urine sample sent for urgent microscopy and culture. In children aged 3 months or older but younger than 3 years, symptoms are easier to identify, and antibiotics should only be started if a dipstick test is positive for either or both leukocyte esterase or nitrite. Children in this age group with a positive dipstick test should also have a urine sample sent for culture.

How the 2017 recommendations might affect practice

Recommending dipstick testing in infants and children aged 3 months or older but younger than 3 years clarifies the role of dipstick testing in this age group and encourages immediate diagnosis and treatment in primary care. The committee believe the new recommendations will provide concise and clear guidance for health care professionals, more efficient diagnosis for infants and children, and cost savings and a reduced burden on laboratories by reducing the number of urine samples sent for culture.

For full details of the evidence and the committee's discussion, see the evidence reviews on diagnosing UTIs in children under 3 years.

  • National Institute for Health and Care Excellence (NICE)