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Give delayed antibiotic scripts to women with UTI, GPs urged

GPs should give delayed antibiotic prescriptions to women with urinary tract infections to reduce use of the drugs, researchers on an NHS-funded trial conclude.

Their study found offering a script delayed by 48 hours reduced antibiotic use without having any significant effect on control of symptoms.

The results of the NHS health technology assessment cast further doubt on the ongoing MHRA consultation to make the antibiotic trimethoprim available over the counter for women with uncomplicated cystitis.

Researchers randomised 3,330 woman in primary care to empirical antibiotics, a 48-hour delayed script, or antibiotic treatment based on results of a symptom score, dipstick test or positive mid-stream urine specimen.

But although the numbers of women using antibiotics varied in the different groups, there was little difference in symptomatic outcomes.

As many as 97% of women given immediate prescriptions for antibiotics took them, compared with 77% of those given prescriptions delayed for 48 hours, and 80% of those who were treated on the basis of a dipstick test.

But researchers found little difference in outcomes. Women suffered 3.5 days of symptoms if they took antibiotics immediately and 4.8 days if they delayed taking antibiotics for 48 hours.

Those commencing antibiotics after 48 hours were 43% less likely to reconsult than those treated immediately, but their symptoms lasted 37% longer. Advice to use bicarbonate or cranberry juice had no effect on any outcome.

Study leader Professor Paul Little, professor of primary care research at the University of Southampton and a GP in the city, concluded: ‘Although all of the strategies trialled are acceptable, to both achieve good symptom control and reduce antibiotic use clinicians should either offer a 48-hour delayed antibiotic prescription - to be used at the patient's discretion - or target antibiotic treatment by dipsticks with the offer of a delayed prescription if dipstick results are negative.'

Dr Aisha Newth, a GP with an interest in women's health in Acton, west London, said her current practice was to offer treatment on the basis of a dipstick test rather than offering delayed prescriptions.

‘If women are symptomatic with a positive dipstick I give antibiotics and so do my colleagues. If the dipstick is negative I send it for a mid-stream urine test. At my practice we are much more guided by the results of dipstick tests than anything else.'

Urine dipstick testing analysis

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