Attitude of Nigerian Paediatricians towards the Management of Acute Pyelonephritis

Abstract

Background: Acute pyelonephritis (APN) is a common renal disorder in children. The manage ment is controversial and has generated a lot of debate globally. There is no consensus on the strategies for its investigation and treatment in Nigeria.

Objective: To determine the attitude of Nigerian paediatricians towards the management of acute pyelonephritis in children.

Materials and Methods: The management attitude of Nigerian paediatricians towards children with acute pyelonephritis was investigated during an annual paediatric conference, using a ques tionnaire containing a brief description of a clinical case of APN in a three-year old female.

Results: Out of 195 questionnaires issued to registered paediatricians, 115 (59.0 percent) were retrieved and analysed. Ninety five (82.6 percent) of the 115 responders were based in tertiary hospitals. All the paediatricians would perform a urine culture and 98 (85.2 percent), including the eight paediatric nephrologists, would request a renal ultrasound during the acute phase of pyelonephritis. Twelve (10.4 percent) respondents would request an intravenous pyelogra (IVU). Fourteen percent and 36 percent respectively, were of the opinion that micturating cystourethrography (MCU) and 99M TC-dimercaptosuccinic acid scintigraphy (DMSA) scan were indicated. Those working in tertiary hospitals would perform both the MCU and DMSA less frequently than those working in private/company hospitals (p>0.05). Significantly more doc tors who graduated in the 1990s would ask for MCU and DMSA scan than those who graduated earlier (p<0.05). Immediate antibiotic treatment was preferred by 96.5 percent, with cephalosporin being the antibiotic of choice in 47.8 percent. Intravenous administration of antibiotics was preferred to the oral route (87.8 percent vs 12.2 percent).

Conclusion: Although the opinion expressed in this study may not reflect the actual practice of the paediatricians, there is a marked variation in the management of APN observed among them. There is a need to establish a protocol of “best treatment" of APN in the country given the varied and frequently limited resources available.

Keywords: Attitude, acute pyelonephritis, management, paediatricians