Attitudes of General Practitioners and Pediatricians to Management of Acute Pyelonephritis in Children

Objective: To study the attitudes of different groups of physicians toward management of acute pyelonephritis in children and the im- pact of such attitudes on the long-term se- quelae of this problem. Materials and Meth- ods: A questionnaire, describing a case histo- ry of a child with acute pyelonephritis, was distributed to general practitioners working in 12 primary health care centers and pedia- tricians working in the pediatric departments of the 6 main hospitals in Kuwait. The re- sponses of the two groups were analyzed regarding their views toward hospitalization of the child, investigations requested, the choice of antibiotics, its route of administra- tion, duration of treatment and the need for long-term follow-up. Results: A total of 83 general practitioners (group A) and 65 hospi- tal 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 fa- vored 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. Conclusion: A marked discrepancy existed in the management of acute pyelone- phritis between the two groups, indicating the need of a unified policy. Children present- ing 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 in- vestigations and follow-up are provided.