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A randomized controlled trial of a diagnostic algorithm for symptoms of uncomplicated cystitis at an out-of-hours service.

Bollestad M, Grude N, Lindbaek M - Scand J Prim Health Care (2015)

Bottom Line: No significant differences were found between the groups in the basic patient demographics, severity of symptoms, or percentage of urine samples with single culture growth.A median of three days until symptomatic resolution was found in both groups.This simplification of treatment strategy can lead to a more rational use of consultation time and a stricter adherence to National Antibiotic Guidelines for a common disorder.

View Article: PubMed Central - PubMed

Affiliation: Out-of-hours Service , Oslo Municipality Norway , Norway.

ABSTRACT

Objective: To compare the clinical outcome of patients presenting with symptoms of uncomplicated cystitis who were seen by a doctor, with patients who were given treatment following a diagnostic algorithm.

Design: Randomized controlled trial.

Setting: Out-of-hours service, Oslo, Norway.

Intervention: Women with typical symptoms of uncomplicated cystitis were included in the trial in the time period September 2010-November 2011. They were randomized into two groups. One group received standard treatment according to the diagnostic algorithm, the other group received treatment after a regular consultation by a doctor.

Subjects: Women (n = 441) aged 16-55 years. Mean age in both groups 27 years.

Main outcome measures: Number of days until symptomatic resolution.

Results: No significant differences were found between the groups in the basic patient demographics, severity of symptoms, or percentage of urine samples with single culture growth. A median of three days until symptomatic resolution was found in both groups. By day four 79% in the algorithm group and 72% in the regular consultation group were free of symptoms (p = 0.09). The number of patients who contacted a doctor again in the follow-up period and received alternative antibiotic treatment was insignificantly higher (p = 0.08) after regular consultation than after treatment according to the diagnostic algorithm. There were no cases of severe pyelonephritis or hospital admissions during the follow-up period.

Conclusion: Using a diagnostic algorithm is a safe and efficient method for treating women with symptoms of uncomplicated cystitis at an out-of-hours service. This simplification of treatment strategy can lead to a more rational use of consultation time and a stricter adherence to National Antibiotic Guidelines for a common disorder.

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Related in: MedlinePlus

Diagnostic algorithm.
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Figure 1: Diagnostic algorithm.

Mentions: In the course of 14 months from September 2010–November 2011, 441 women in the age group 16–55 years were included. Patients eligible for inclusion were identified by use of a diagnostic algorithm as shown in Figure 1. Women presenting with dysuria and increased frequency of urination were included. Visible haematuria and increased urge for urination were also registered, but did not determine inclusion. Criteria for exclusion were relevant comorbidity (diabetes, kidney disease, and oesophageal passage problems), symptoms indicative of pyelonephritis or a complicated UTI, symptoms indicative of a sexually transmitted infection (STI), ongoing antibiotic/probenecid treatment, or a previous allergic reaction to penicillin. Temperature was measured and ongoing fever led to exclusion.


A randomized controlled trial of a diagnostic algorithm for symptoms of uncomplicated cystitis at an out-of-hours service.

Bollestad M, Grude N, Lindbaek M - Scand J Prim Health Care (2015)

Diagnostic algorithm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834504&req=5

Figure 1: Diagnostic algorithm.
Mentions: In the course of 14 months from September 2010–November 2011, 441 women in the age group 16–55 years were included. Patients eligible for inclusion were identified by use of a diagnostic algorithm as shown in Figure 1. Women presenting with dysuria and increased frequency of urination were included. Visible haematuria and increased urge for urination were also registered, but did not determine inclusion. Criteria for exclusion were relevant comorbidity (diabetes, kidney disease, and oesophageal passage problems), symptoms indicative of pyelonephritis or a complicated UTI, symptoms indicative of a sexually transmitted infection (STI), ongoing antibiotic/probenecid treatment, or a previous allergic reaction to penicillin. Temperature was measured and ongoing fever led to exclusion.

Bottom Line: No significant differences were found between the groups in the basic patient demographics, severity of symptoms, or percentage of urine samples with single culture growth.A median of three days until symptomatic resolution was found in both groups.This simplification of treatment strategy can lead to a more rational use of consultation time and a stricter adherence to National Antibiotic Guidelines for a common disorder.

View Article: PubMed Central - PubMed

Affiliation: Out-of-hours Service , Oslo Municipality Norway , Norway.

ABSTRACT

Objective: To compare the clinical outcome of patients presenting with symptoms of uncomplicated cystitis who were seen by a doctor, with patients who were given treatment following a diagnostic algorithm.

Design: Randomized controlled trial.

Setting: Out-of-hours service, Oslo, Norway.

Intervention: Women with typical symptoms of uncomplicated cystitis were included in the trial in the time period September 2010-November 2011. They were randomized into two groups. One group received standard treatment according to the diagnostic algorithm, the other group received treatment after a regular consultation by a doctor.

Subjects: Women (n = 441) aged 16-55 years. Mean age in both groups 27 years.

Main outcome measures: Number of days until symptomatic resolution.

Results: No significant differences were found between the groups in the basic patient demographics, severity of symptoms, or percentage of urine samples with single culture growth. A median of three days until symptomatic resolution was found in both groups. By day four 79% in the algorithm group and 72% in the regular consultation group were free of symptoms (p = 0.09). The number of patients who contacted a doctor again in the follow-up period and received alternative antibiotic treatment was insignificantly higher (p = 0.08) after regular consultation than after treatment according to the diagnostic algorithm. There were no cases of severe pyelonephritis or hospital admissions during the follow-up period.

Conclusion: Using a diagnostic algorithm is a safe and efficient method for treating women with symptoms of uncomplicated cystitis at an out-of-hours service. This simplification of treatment strategy can lead to a more rational use of consultation time and a stricter adherence to National Antibiotic Guidelines for a common disorder.

Show MeSH
Related in: MedlinePlus