Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial
Little, P., Moore, M. , Turner, S., Rumsby, K., Warner, G., Lowes, J., Smith, H., Hawke, C., Leydon, G., Arscott, A., Turner, D. and Mullee, M. (2010) Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. British Medical Journal, 340, (c199), 1-6. (doi:10.1136/bmj.c199).
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Description/Abstract
Objective: To assess the impact of different management strategies in urinary tract infections.
Design: Randomised controlled trial.
Setting: Primary care
Participants: 309 non-pregnant women aged 18-70 presenting with suspected urinary tract infection.
Intervention: Patients were randomised to five management approaches: empirical antibiotics; empirical delayed (by 48 hours) antibiotics; or targeted antibiotics based on a symptom score (two or more of urine cloudiness, urine smell, nocturia, or dysuria), a dipstick result (nitrite or both leucocytes and blood), or a positive result on midstream urine analysis. Self help advice was controlled in each group.
Main outcome measures: Symptom severity (days 2 to 4) and duration, and use of antibiotics.
Results: Patients had 3.5 days of moderately bad symptoms if they took antibiotics immediately. There were no significant differences in duration or severity of symptoms (mean frequency of symptoms on a 0 to 6 scale: immediate antibiotics 2.15, midstream urine 2.08, dipstick 1.74, symptom score 1.77, delayed antibiotics 2.11; likelihood ratio test for the five groups P=0.177).
There were differences in antibiotic use (immediate antibiotics 97%, midstream urine 81%, dipstick 80%, symptom score 90%, delayed antibiotics 77%; P=0.011) and in sending midstream urine samples (immediate antibiotics 23%, midstream urine 89%, dipstick 36%, symptom score 33%, delayed antibiotics 15%; P<0.001).
Patients who waited at least 48 hours to start taking antibiotics reconsulted less (hazard ratio 0.57 (95% confidence interval 0.36 to 0.89), P=0.014) but on average had symptoms for 37% longer than those taking immediate antibiotics (incident rate ratio 1.37 (1.11 to 1.68), P=0.003), particularly the midstream urine group (73% longer, 22% to 140%; none of the other groups had more than 22% longer duration).
Conclusion: All management strategies achieve similar symptom control. There is no advantage in routinely sending midstream urine samples for testing, and antibiotics targeted with dipstick tests with a delayed prescription as backup, or empirical delayed prescription, can help to reduce antibiotic use.
| Item Type: | Article |
|---|---|
| ISSNs: | 0959-8138 |
| Subjects: | R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
| Divisions: | University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences |
| Item ID: | 143631 |
| Date Deposited: | 12 Apr 2010 13:54 |
| Last Modified: | 10 Aug 2012 13:44 |
| Contributors: | Little, P. (Author) Moore, M. (Author) Turner, S. (Author) Rumsby, K. (Author) Warner, G. (Author) Lowes, J. (Author) Smith, H. (Author) Hawke, C. (Author) Leydon, G. (Author) Arscott, A. (Author) Turner, D. (Author) Mullee, M. (Author) |
| Date: | 5 February 2010 |
| Status: | Published |
| URI: | http://eprints.soton.ac.uk/id/eprint/143631 |
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