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Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial

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posted on 2023-06-08, 12:04 authored by P Little, M V Moore, S Turner, K Rumby, G Warner, J A Lowes, H Smith, C Hawke, G Leydon, A Arscott, D Turner, M Mullee
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. Study registration National Research Register N0484094184 ISRCTN: 03525333.

History

Publication status

  • Published

File Version

  • Published version

Journal

BMJ

ISSN

1759-2151

Publisher

BMJ Publishing Group

Issue

c199

Volume

340

Department affiliated with

  • Primary Care and Public Health Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2012-07-13

First Open Access (FOA) Date

2012-07-13

First Compliant Deposit (FCD) Date

2012-07-03

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