Primary Care Medical Group, Community Clinical Sciences Division, University of Southampton School of Medicine, Southampton SO16 5ST.
BMJ. 2010 Feb 5;340:c199. doi: 10.1136/bmj.c199.
To assess the impact of different management strategies in urinary tract infections.
Randomised controlled trial.
Primary care.
309 non-pregnant women aged 18-70 presenting with suspected urinary tract infection.
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.
Symptom severity (days 2 to 4) and duration, and use of antibiotics.
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).
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.
National Research Register N0484094184 ISRCTN: 03525333.
评估不同管理策略对尿路感染的影响。
随机对照试验。
初级保健。
309 名年龄在 18-70 岁之间、有疑似尿路感染的非孕妇。
患者被随机分为五种管理方法：经验性抗生素治疗；经验性延迟（48 小时后）抗生素治疗；或基于症状评分（尿液混浊、尿液气味、夜尿症或尿痛两项或两项以上）、尿沉渣结果（亚硝酸盐或白细胞和血液）、或中段尿分析阳性结果的靶向抗生素治疗。在每个组中都控制了自我帮助建议。
症状严重程度（第 2-4 天）和持续时间，以及抗生素的使用。
如果患者立即使用抗生素，他们将有 3.5 天的中度严重症状。症状持续时间或严重程度没有显著差异（0 到 6 分的症状频率平均值：立即使用抗生素 2.15，中段尿 2.08，尿沉渣 1.74，症状评分 1.77，延迟使用抗生素 2.11；五组间的似然比检验 P=0.177）。抗生素使用（立即使用抗生素 97%，中段尿 81%，尿沉渣 80%，症状评分 90%，延迟使用抗生素 77%；P=0.011）和中段尿样本送检（立即使用抗生素 23%，中段尿 89%，尿沉渣 36%，症状评分 33%，延迟使用抗生素 15%；P<0.001）存在差异。至少等待 48 小时开始使用抗生素的患者再次就诊的次数更少（风险比 0.57（95%置信区间 0.36 至 0.89），P=0.014），但平均症状持续时间比立即使用抗生素的患者长 37%（发生率比 1.37（1.11 至 1.68），P=0.003），尤其是中段尿组（长 73%，22%至 140%；其他组均无超过 22%的持续时间延长）。
所有管理策略均能达到相似的症状控制效果。常规送检中段尿样本进行检测没有优势，使用尿沉渣检测联合延迟处方的靶向抗生素治疗，或经验性延迟处方，可以帮助减少抗生素的使用。
英国国家研究注册处 N0484094184 ISRCTN: 03525333。
