Attitudes of general practitioners and pediatricians to management of acute pyelonephritis in children

ABSTRACT

To study the attitudes of different groups of physicians toward management of acute pyelonephritis in children and the impact of such attitudes on the long-term sequelae of this problem. Materials and A questionnaire, describing a case history of a child with acute pyelonephritis, was distributed to general practitioners working in 12 primary health care centers and pediatricians working in the pediatric departments of the 6 main hospitals in Kuwait. The responses of the two groups were analyzed regarding their views toward hospitalization of the child, investigations requested, the choice of antibiotics, its route of administration, duration of treatment and the need for long-term follow-up. A total of 83 general practitioners [group A] and 65 hospital pediatricians [group B] responded to the questionnaire. Hospitalization of the child was thought to be essential by 19% of group A compared to 89% of group B [p < 0.0001]. Only 25% of group A decided to fully investigate the child compared to 58% of group B [p < 0.0001]. Treatment with a single antibiotic was preferred by 72% of group A compared to 80% of group B. Only 6% of group A, compared to 74% of group B favored parenteral antibiotics [p < 0.0001]. A 7-day course of treatment was considered by 70% of group A and 52% of group B [p < 0.02]. Long-term follow-up was thought to be necessary by 63% of group A and 75% of group B. A marked discrepancy existed in the management of acute pyelonephritis between the two groups, indicating the need of a unified policy. Children presenting with such a problem can be managed by general practitioners on an outpatient basis provided that proper antibiotics are used, compliance is ensured and appropriate investigations and follow-up are provided