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GMC to delegate minor complaints

As new rules emerged to help GPs manage suspected UTIs, researchers warned antibiotics are still overused

A simple dipstick test or a series of clinical rules could be used to target antibiotic prescriptions for urinary tract infections, a new study finds.

GPs said the model would be particularly useful for out-of-hours work, when a rapid diagnosis was usually required, but urged GPs to otherwise send urine samples to the laboratory to confirm a UTI.

The research showed a dipstick test, based on whether patients had either nitrites or both leucocytes and blood in the urine, had a sensitivity of 77 per cent and a specificity of 70 per cent for identifying UTIs.

The 'clinical rule' model, based on patients having two out of four clinical features, was less sensitive at 65 per cent and slightly less specific at 69 per cent. The clinical features were cloudy urine, urine with an offensive smell, moderately severe dysuria, and moderately severe nocturia.

Study leader Professor Paul Little, professor of primary care research at the University of Southampton and a GP in Romsey, Hampshire, said if there were three clinical features he would 'immediately' prescribe antibiotics as this related to an 84 per cent chance the patient had an UTI.

The research, which has been submitted to the British Journal of General Practice, was based on 427 women presenting with a suspected UTI in GP surgeries. The clinical rule and dipstick test were compared with laboratory diagnosis of a UTI.

Professor Little, who presented the findings last week at the Society for Academic Primary Care conference in Gateshead, said: 'If there were no clinical features then I would, personally, not offer antibiotics but ask them to

return if symptoms were not settling.

'If there were three or more features I would offer immediate antibiotics and delay the offer of antibiotics to those in the middle.'

Dr Chaand Nagpaul, a member of the BMA's public health committee and a GP in Harrow, Middlesex, said: 'The rules are helpful in certain circumstances but I would not see them as a replacement of the need to send samples to the lab.'

He added: 'Most GPs can get results in a day or two. Where these rules are helpful is out of hours.'

UTI predictor

Dipstick rule

Patients with either of the following features

·Nitrites

·Leucocytes and blood

Sensitivity 77% Specificity 70%

Clinical rule

Patients with two of the following features:

·Urine cloudiness

·Urine with an offensive smell

·Moderate to severe dysuria

·Moderate to severe nocturia

Sensitivity 65% Specificity 69%

By Nerys Hairon

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