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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

Symptom resolution: Percentage of patients with remaining symptoms versus number of days since the start of treatment, Kaplan–Meier plot. Blue line: Treated according to the diagnostic algorithm. Green line: Treatment chosen after a doctor's consultation. P-value (log rank): 0.3.
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Figure 3: Symptom resolution: Percentage of patients with remaining symptoms versus number of days since the start of treatment, Kaplan–Meier plot. Blue line: Treated according to the diagnostic algorithm. Green line: Treatment chosen after a doctor's consultation. P-value (log rank): 0.3.

Mentions: The main outcome measurement of the study was the number of days until symptomatic resolution in the two groups as shown in a Kaplan-Meier plot (Figure 3). By day four 188 of 238 (79%) in the group treated according to the diagnostic algorithm and 134 of 187 (72%) in the control group were free of symptoms (p = 0.09). A median of three days until symptom resolution was found in both groups, log rank test p = 0.3.


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)

Symptom resolution: Percentage of patients with remaining symptoms versus number of days since the start of treatment, Kaplan–Meier plot. Blue line: Treated according to the diagnostic algorithm. Green line: Treatment chosen after a doctor's consultation. P-value (log rank): 0.3.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Symptom resolution: Percentage of patients with remaining symptoms versus number of days since the start of treatment, Kaplan–Meier plot. Blue line: Treated according to the diagnostic algorithm. Green line: Treatment chosen after a doctor's consultation. P-value (log rank): 0.3.
Mentions: The main outcome measurement of the study was the number of days until symptomatic resolution in the two groups as shown in a Kaplan-Meier plot (Figure 3). By day four 188 of 238 (79%) in the group treated according to the diagnostic algorithm and 134 of 187 (72%) in the control group were free of symptoms (p = 0.09). A median of three days until symptom resolution was found in both groups, log rank test p = 0.3.

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