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GPs need UTI script guide

Further research is being demanded to guide GP prescribing after a study showed decisions to give antibiotics bore little relation to the actual presence of urinary tract infections, writes Helen Crump.

The study found six out of 10 patients prescribed antibiotics had a negative culture and concluded current management strategies should be reviewed as they were not succeeding in improving targeting of antibiotics.Study leader Dr Kathryn O'Brien, a GP in Brynmawr, Wales, demanded further research to clarify which patients with symptoms suggestive of UTI were most likely to benefit from antibiotics so the problem of unnecessary antibiotic prescribing and antibiotic resistance could be addressed. Dr O'Brien said: 'What we really need is more research to try and be able to target antibiotics, to find out which women do benefit from antibiotics and which you can avoid them in.'As a GP, what you really need is a way of targeting antibiotics to those most likely to benefit.' GPs in nine practices in South Wales were asked to submit urine specimens from all women consulting with clinically suspected, uncomplicated UTI in the study. Patients were followed up by questionnaire. Antibiotics were prescribed empirically in 61% of cases, but 60% of those prescribed empirical antibiotics were subsequently found to have a negative culture, and 25% of those found to have a positive culture were not prescribed antibiotics.Dr Ashok Deshpande, a GPSI in urology at Havering PCT, said pick-up rates on cultures could often vary but dipstick tests were a 'reasonably reliable' guide to whether GPs should prescribe.Dr Deshpande said: 'In our practice, the dipstick test is done first of all. You get an idea if there are lots of white cells in it, nitrates and proteins. If a negative culture is shown later, you can safely reassure patients and do another culture to see if you have missed it.'The study was published early online by the Journal of Antimicrobial Chemotherapy.

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