Antibiotics may be delayed for UTI
by Michael Woodhead
Urinary dipsticks may help reduce antibiotic prescribing in women presenting with symptoms suggestive of urinary tract infections, but the effect is modest, new research by GPs in the UK shows.
A comparison of five different approaches to the management of UTI found little difference in symptom control between the use of empirical antibiotics or antibiotics targeted by dipstick results. There was also no difference in symptom control when a delayed antibiotic prescription was used or when antibiotics were targeted according to symptoms (such as nocturia, dysuria, urine cloudiness or smell).
Rates of antibiotic use were reduced by 20-25% when treatment was delayed or guided by dipstick results, but this reduction was relatively modest compared to the results seen with similar ‘delayed prescription’ strategies in people with respiratory tract infections, the study authors note in the BMJ (online 5 February).
The study also found that patients who waited 48 hours had symptoms for 37% longer than those who used immediate antibiotics, and the effect was most pronounced in those who had treatment delayed until results of a midstream urine test were available.
“There is no advantage in routinely sending midstream urine samples, and patients who delay waiting for results of such analysis ... might have poor symptom control,” the authors say.
They comment that the modest reduction in antibiotic use with delayed prescriptions may be useful from a public health point of view, but delayed prescriptions will be less useful in UTI given that two out of three suspected UTIs are bacterial.
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8 February 2010
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