Diagnostic testing strategies in childhood urinary tract infections

Appropriate use of antibiotics for common infections in an era of increasing resistance

In many respects, antibiotics have changed medicine forever. Countless lives have been enhanced and saved with antibiotic use. Unfortunately, the medical community has opened Pandora's box through the casual distribution of outpatient antibiotics. Society will indeed suffer, as well as the medical profession, if antibiotics are not used judiciously. To date, the rate of penicillin resistance has steadily risen in North America and in many other areas of the world. Much of the increase in resistance has been caused by the distribution of antibiotics for viral infections (e.g., bronchitis, colds, or purulent nasal discharge) as well as nonstreptococcal throat infections. Parental pressure for physicians to prescribe antibiotics also has contributed to the rise in antibiotic resistance. The authors have discussed many common pediatric ED infections and have illustrated the key points for making the diagnosis of each. In addition, the authors also recommend the appropriate choice of antibiotics for each disease process, with an emphasis on narrow-spectrum, first-line antimicrobials. Physicians, as the "holders of the prescription pad," should be aware of the problems with increasing bacterial resistance especially ED practitioners who work on the front line. In addition, families and patients should be educated about the harm of inappropriate antibiotic use. The AAP publishes pamphlets for parents that discuss these issues. It is believed, as was seen in Finland and Japan, that judicious use of antibiotics leads to a decrease in resistant bacteria and prolong antibiotic usefulness. This is an issue of great importance to the long-term health of patients. What Benjamin Rush stated in 1789 is true today: "Do not condemn, or oppose, unnecessarily, the simple, prescriptions of your patients. Yield to them in matters of little consequence but maintain an inflexible authority over matters that are essential to life."

Office laboratory procedures, office economics, parenting and parent education, and urinary tract infection

We again review four areas of interest to office-based pediatricians: office laboratory procedures, office economics, parenting and patient education, and urinary tract infections. Sean Elliott provides an update on the Clinical Laboratories Improvement Amendments (CLIA) and their impact of office practice. Eve Shapiro reviews office economics, focusing on measuring quality of care, use of performance data, costs of new technologies, and the impact of managed care on the medical marketplace. John Walter offers an update on parenting and parent education, with approaches to counseling families about overuse of antibiotics, teen pregnancy, hyperactivity, violence, and asthma. Richard Wahl reviews the recent research on urinary tract infection, with special attention paid to office diagnosis and management, longitudinal studies of children with urinary tract infections, and the controversy surrounding the American Academy of Pediatrics Task Force on Circumcision report.