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January 2008
Evidence-Based Tip
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Laura Cousineau, MLS
MUSC Library
Dept. of Pediatrics EBM Faculty |
Urinary Tract Infections in Children
My responsibilities as the EBM librarian for Pediatrics allow me to round once a week with the residents and medical students. My job on rounds is to facilitate EBM in action - helping them to form a good clinical question, to PICO it for clarification, to find the evidence, and to discuss its applicability to the patient. Anywhere from three to eight questions may arise, along with many good, teachable moments.
While on rounds last month, we had a case of a child with a urinary tract infection (UTI) due to urogenital abnormalities. The child was soon to be released from the hospital with a regime of prophylactic anti-infective agents. I turned to the medical students and asked them if other children with no abnormalities but with recurrent UTI should be prescribed prophylactic agents.
They chose to present on this question in the final session of their Pediatric Roundtable rotation.
Their question:
Do prophylactic antibiotics decrease the incidence of recurrent urinary tract infections in children?
Their PICO (population, intervention, comparison, outcome):
P: Children with urinary tract infections
I: Prophylactic antibiotics
C: Usual care of UTI, no prophylactic antibiotics
O: Recurrence of UTI
After their search, they selected as the best level of evidence:
Williams GJ, Wei L, Lee A, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database of Systematic Reviews 2006, Issue 3.
With the help of this top-level evidence, they were able to conclude that they would not recommend prophylactic antibiotics. The studies showed that although certain antibiotics may prevent infections from reoccurring, the side effects of these drugs could make the children feel more unwell than the infection itself.
An important characteristic of a well-done systematic review, such as those in Cochrane, is the ability to quickly find implications for practice. Because of the thoroughness of the search and the expert analysis of the methodology and validity of the research found, health care providers can put more confidence in the recommendations of these systematic reviews. Coupled with that analysis, a quick look at the tables provides information about the therapies and outcomes most relevant to a patient's care.
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| One of the tables in this Cochrane Review. Although one intervention favors the antibiotic, the review points out the flaws in that study that may over inflate the treatment benefits. |
I was very proud of the medical students who presented that day. They did a good job formulating the question, then searching and finding the best evidence. They did a thorough evaluation of the evidence they found, and drew conclusions for their practice. It makes me feel that their patients will be in very good hands. They will have more than the knowledge base learned in medical school. They will have ability to constantly upgrade their knowledge, and treat their patients on the basis of the best available evidence.
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