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

Little, P., Moore, M. V., Turner, S., Rumsby, K., Warner, G., Lowes, J. A., Smith, H., Hawke, C., Leydon, G., Arscott, A., Turner, D. ORCID: https://orcid.org/0000-0002-1689-4147 and Mullee, M. (2010) Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. British Medical Journal (BMJ), 340 (feb05 1). c199. ISSN 0959-8138

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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. Study registration: National Research Register N0484094184 ISRCTN: 03525333.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Groups > Health Economics Faculty of Medicine and Health Sciences > Research Centres > Population Health Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Depositing User:	Users 2731 not found.
Date Deposited:	05 Dec 2012 11:13
Last Modified:	20 Mar 2024 15:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/40385
DOI:	10.1136/bmj.c199

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