By Lilian Anekwe
GPs are being advised against the routine use of midstream urine test for women with uncomplicated urinary tract infections, after research found it did not improve symptom control but was the most expensive of five treatment strategies.
A series of studies published in the BMJ compared five different management strategies: urine dipstick testing, treatment based on clinical symptoms, a prescription delayed by 48 hours, midstream urine testing and a control of immediate empirical antibiotic treatment.
Researchers randomised 309 patients to one of the five treatment strategies and then measured patients’ symptom severity, duration and use of antibiotics.
There were no significant differences in either the duration or severity of symptoms in women in different treatment groups, but the researchers did find a significant difference in antibiotic use.
97% of women given an immediate prescription used their antibiotics, compared with 81% treated according to the results of a midstream urine analysis, 80% treated on the basis of urine dipstick testing and 90% by symptom score. By comparison, 77% of women given delayed prescriptions recorded taken the antibiotics, and were 43% less likely to reconsult than those given immediate antibiotics, but their symptoms lasted 37% longer.
A second study by the same group analysed the cost-effectiveness of the five strategies and estimated the cost of care for each strategy over 30 days. They found the midstream urine strategy was the most expensive, with a mean cost of £37, followed by dipstick testing at £36. The cheapest option was immediate prescription, at £31.
The authors concluded that all five strategies had similar costs and symptom control, and there is no strong reason for GPs to prefer any on the basis of cost.
Lead author Professor Paul Little, professor of primary care research at the University of Southampton and a GP in the city, said: ‘All management strategies achieve similar symptom control. There is no advantage in routinely sending midstream urine samples for testing, and antibiotics targeted with dipstick tests with a delayed prescription as backup, or empirical delayed prescription, can help to reduce antibiotic use.’
In an accompanying editorial, professor Dee Mangin, director of primary acre research at the Christchurch school of Medicine in New Zealand, said midstream urine sampling is ‘clearly unhelpful and expensive’.
‘Delayed empirical prescription or dipstick guided delayed options will reduce the likelihood of the patient having to take antibiotics at all, but delaying antibiotics by two or more days increases the risk for the patient that more severe symptoms will be prolonged. Women can also be warned that if their initial symptoms are severe or if they have had cystitis before, they are likely to have severe symptoms for at least three days.’
BMJ online first 5 February 2010
GPs have been advised midstream urine tests for UTIs do not increase symptoms control and are expensive