scholarly journals Effect of point-of-care susceptibility testing in general practice on appropriate prescription of antibiotics for patients with uncomplicated urinary tract infection: a diagnostic randomised controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e018028 ◽  
Author(s):  
Anne Holm ◽  
Gloria Cordoba ◽  
Tina Møller Sørensen ◽  
Lisbeth Rem Jessen ◽  
Niels Frimodt-Møller ◽  
...  
Keyword(s):  
General Practice ◽  
Urinary Tract Infection ◽  
Susceptibility Testing ◽  
Point Of Care ◽  
Controlled Trial ◽  
Antibiotic Prescribing ◽  
Uncomplicated Urinary Tract Infection ◽  
First Line ◽  
Randomised Controlled ◽  
Microbiological Cure

ObjectivesTo investigate the effect of adding point-of-care (POC) susceptibility testing to POC culture on appropriate use of antibiotics as well as clinical and microbiological cure for patients with suspected uncomplicated urinary tract infection (UTI) in general practice.DesignOpen, individually randomised controlled trial.SettingGeneral practice.ParticipantsWomen with suspected uncomplicated UTI, including elderly patients above 65, patients with recurrent UTI and patients with diabetes. The sample size calculation predicted 600 patients were needed.InterventionsFlexicult SSI-Urinary Kit was used for POC culture and susceptibility testing and ID Flexicult was used for POC culture only.Main outcome measuresPrimary outcome: appropriate antibiotic prescribing on the day after consultation defined as either (1) patient with UTI: to prescribe a first-line antibiotic to which the infecting pathogen was susceptible or a second line if a first line could not be used or (2) patient without UTI: not to prescribe an antibiotic. UTI was defined by typical symptoms and significant growth in a reference urine culture performed at one of two external laboratories.Secondary outcomes: clinical cure on day five according to a 7-day symptom diary and microbiological cure on day 14. Logistic regression models taking into account clustering within practices were used for analysis.Results20 general practices recruited 191 patients for culture and susceptibility testing and 172 for culture only. 63% of the patients had UTI and 12% of these were resistant to the most commonly used antibiotic, pivmecillinam. Patients randomised to culture only received significantly more appropriate treatment (OR: 1.44 (95% CI 1.03 to 1.99), p=0.03). There was no significant difference in clinical or microbiological cure.ConclusionsAdding POC susceptibility testing to POC culture did not improve antibiotic prescribing for patients with suspected uncomplicated UTI in general practice. Susceptibility testing should be reserved for patients at high risk of resistance and complications.Trial registration numberNCT02323087; Results.

scholarly journals Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e035074
Author(s):  
Ingvild Vik ◽  
Ibrahimu Mdala ◽  
Marianne Bollestad ◽  
Gloria Cristina Cordoba ◽  
Lars Bjerrum ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Logistic Regression ◽  
Urinary Tract ◽  
Randomised Controlled Trial ◽  
Tract Infection ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Uncomplicated Urinary Tract Infection ◽  
Baseline Information ◽  
Randomised Controlled

ObjectiveTo predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated urinary tract infection (UTI).Setting16 sites in a primary care setting in Norway, Sweden and Denmark.ParticipantsData from 181 non-pregnant women aged 18–60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen.MethodsUsing the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics.ResultsOf the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0–6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74).ConclusionWe did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate.Trial registration numberClinicalTrials.gov (NCT01849926).

scholarly journals Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101600 ◽  
Author(s):  
Marjolein JC Schot ◽  
Ann Van den Bruel ◽  
Berna DL Broekhuizen ◽  
Jochen WL Cals ◽  
Eveline A Noteboom ◽  
...  
Keyword(s):  
General Practice ◽  
Randomised Controlled Trial ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Controlled Trial ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomised Controlled

BackgroundOverprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid.AimTo assess whether use of POC CRP by the GP reduces antibiotic prescriptions in children with suspected non-serious LRTI.Design & settingAn open, pragmatic, randomised controlled trial in daytime general practice and out-of-hours services.MethodChildren between 3 months and 12 years of age with acute cough and fever were included and randomised to either use of POC CRP or usual care. Antibiotic prescription rates were measured and compared between groups using generalising estimating equations.ResultsThere was no statistically significant reduction in antibiotic prescriptions in the GP use of CRP group (30.9% versus 39.4%; odds ratio [OR] 0.6; 95% confidence interval [CI] = 0.29 to 1.23). Only the estimated severity of illness was related to antibiotic prescription. Forty-six per cent of children had POC CRP levels <10mg/L.ConclusionIt is still uncertain whether POC CRP measurement in children with non-serious respiratory tract infection presenting to general practice can reduce the prescription of antibiotics. Until new research provides further evidence, POC CRP measurement in these children is not recommended.

scholarly journals Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial

BMJ ◽  
2015 ◽  
pp. h6544 ◽  
Author(s):  
Ildikó Gágyor ◽  
Jutta Bleidorn ◽  
Michael M Kochen ◽  
Guido Schmiemann ◽  
Karl Wegscheider ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Randomised Controlled Trial ◽  
Tract Infection ◽  
Controlled Trial ◽  
Uncomplicated Urinary Tract Infection ◽  
Randomised Controlled

scholarly journals Effects of primary care C-reactive protein point-of-care testing on antibiotic prescribing by general practice staff: pragmatic randomised controlled trial, England, 2016 and 2017

2020 ◽  
Vol 25 (44) ◽  
Author(s):  
Charlotte Victoria Eley ◽  
Anita Sharma ◽  
Hazel Lee ◽  
Andre Charlett ◽  
Rebecca Owens ◽  
...  
Keyword(s):  
Point Of Care ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Acute Cough ◽  
Reactive Protein ◽  
General Practices ◽  
Randomised Controlled ◽  
Pragmatic Randomised Controlled Trial

Background C-reactive protein (CRP) testing can be used as a point-of-care test (POCT) to guide antibiotic use for acute cough. Aim We wanted to determine feasibility and effect of introducing CRP POCT in general practices in an area with high antibiotic prescribing for patients with acute cough and to evaluate patients’ views of the test. Methods We used a McNulty–Zelen cluster pragmatic randomised controlled trial design in general practices in Northern England. Eight intervention practices accepted CRP testing and eight control practices maintained usual practice. Data collection included process evaluation, patient questionnaires, practice audit and antibiotic prescribing data. Results Eight practices with over 47,000 patient population undertook 268 CRP tests over 6 months: 78% of patients had a CRP < 20 mg/L, 20% CRP 20–100 mg/L and 2% CRP > 100 mg/L, where 90%, 22% and 100%, respectively, followed National Institute for Health and Care Excellence (NICE) antibiotic prescribing guidance. Patients reported that CRP testing was comfortable (88%), convenient (84%), useful (92%) and explained well (85%). Patients believed CRP POCT aided clinical diagnosis, provided quick results and reduced unnecessary antibiotic use. Intervention practices had an estimated 21% reduction (95% confidence interval: 0.46–1.35) in the odds of prescribing for cough compared with the controls, a non-significant but clinically relevant reduction. Conclusions In routine general practice, CRP POCT use was variable. Non-significant reductions in antibiotic prescribing may reflect small sample size due to non-use of tests. While CRP POCT may be useful, primary care staff need clearer CRP guidance and action planning according to NICE guidance.

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