Abstract

Urinary tract infections (UTIs) are common in young children, but their non-specific symptoms and the challenges of collecting urine samples make diagnosis difficult in primary care. Overdiagnosis and inappropriate antibiotic prescribing in this group can contribute to antimicrobial resistance and delay appropriate treatment. The National Institute for Health and Care Excellence (NICE) provides clear recommendations in NG224 for diagnosing and managing UTIs in children under 16. However, adherence to this guideline in general practice remains under-evaluated. This audit assessed how well a GP surgery in Skelmersdale, England, followed NG224 for managing suspected UTIs in children aged 3 months to 3 years, aiming to identify areas for improvement.

A retrospective audit was conducted at Ashurst Primary Care over 12 months (Feb 2024–Feb 2025). Using EMIS, children aged 3 months to 3 years coded with suspected UTIs were identified. After applying inclusion and exclusion criteria, 14 eligible patient consultations were manually reviewed (table 1). This audit assessed compliance against three NG224-derived criteria (table 2). Data was recorded in Excel, and reasons for deviation were qualitatively documented. These insights helped inform targeted recommendations for improvement.

Compliance with Criterion 1 was 71.4% (10/14). The four non-compliant cases were largely attributed to parental pressure, the unavailability of a sample during consultation, or clinical judgement in the context of an unwell child. Criterion 2 showed 57.1% compliance. Of the seven children with positive dipstick results, four were appropriately managed with antibiotics and a culture sent, while three were not. These exceptions were due to clinical discretion, presence of blood on dipstick, or non-urgent presentations where safety-netting was provided. Criterion 3 showed 100% compliance; hence, all three children with negative dipsticks were appropriately not prescribed antibiotics. These results demonstrate strong adherence when dipstick indicators are negative, but variable consistency when follow-up with microbiological testing is required.

This audit highlights a real-world gap between NICE guidelines and clinical practice in managing paediatric UTIs. These findings may reflect common challenges in primary care nationwide, suggesting wider applicability of the proposed interventions. Targeted interventions such as EMIS pop-up alerts prompting urine collection and clinician-signed commitment posters may act as effective behavioural cues and reminders. These tools aim to support time-pressured clinicians in making guideline-aligned decisions and reducing practice variability. A re-audit will be conducted following implementation to evaluate improvement and complete the audit cycle.