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GP guidance on UTI testing should undergo NICE review, says health minister



GPs could face a change to guidance for testing in recurrent urinary tract infections, after a health minister said NICE should consider evidence suggesting current diagnostic tests miss half of infections.

Nicola Blackwood, parliamentary under-secretary of state for health, told MPs she had asked NICE experts to look at evidence reported by a specialist clinic in north London that claims to have successfully treated many patients plagued by debilitating symptoms of recurrent UTIs – despite being told they do not have an infection.

The move comes after a House of Commons motion put forward by Hornsey & Wood Green MP Catherine West about the inadequacies of current testing regimes, which involve culture of mid-stream urine specimens to identify bacterial infection in people with recurrent symptoms.

However, current laboratory culture methods are thought to miss 50% of infections and patients may not then receive appropriate follow-up.

NICE does not have specific guidelines on UTIs in adults but produced a Quality Standard last year advising that urine culture should be done to guide a change in antibiotic treatment in people who do not initially respond.

Ms West highlighted alternative methods used by Professor James Malone-Lee at his clinic at the Whittington Hospital, where patients with recurrent UTI symptoms are diagnosed on the basis of their symptoms and microscopic analysis of urine, and treated with long-term courses of narrow-spectrum antibiotics.

Ms Blackwood said that NICE had not yet addressed ‘the specific issues relating to detecting UTIs raised by Professor Malone-Lee and his team of researchers’.

She added: ‘The evidence surveillance team at NICE has been asked to take into account any publications emerging from Professor Malone-Lee’s work when it next considers the relevant guidance for review.

‘I would encourage Professor Malone-Lee, the Cystitis and Overactive Bladder Foundation and the hon. Lady to take this opportunity to ensure that NICE is kept updated with the latest research… as I have no doubt that it will be helpful in improving guidance in this area.’

Ms Blackwood also highlighted that studies are exploring new methods of urine collection to improve diagnostic accuracy and potential alternatives to prophylactic antibiotics.

Dr Jonathan Rees, chair of the Primary Care Urology Society and a GP in Somerset, welcomed the minister’s comments.

Dr Rees told Pulse: ‘I would be delighted to see a review of this often neglected area of medicine. I am aware through my work, both in general practice and in community urology clinics, of the huge numbers of people suffering from recurrent urinary tract infections.

‘Our diagnostic tools are not up to scratch, and we lack strong guidance on the management particularly of recurrent or chronic symptoms (including when to suspect chronic bladder pain syndrome/interstitial cystitis).’

But Dr Rees added that ‘the use of non-antibiotic measures to reduce the impact of recurrent UTI is underemphasised’.

A NICE spokesperson said: ‘We conduct regular reviews of our published guidance taking into account any relevant new evidence. Information on Professor Malone-Lee’s work has been received by NICE and has been passed onto our guidance team so it can be taken into account when any relevant guidance is next reviewed.’

Recurrent UTI – what NICE says

NICE has not produced its own specific guideline on UTI in adults, but it produced a quality standard in 2015, which states that ‘a urine culture is needed to guide a change in antibiotic treatment in people who do not respond to initial treatment with antibiotics’.[1]

In a separate Clinical Knowledge Summary, NICE also refers to previous Health Protection Agency advice that GPs should send urine for culture from women with recurrent UTI.

[1] NICE QS90 – Urinary tract infections in adults

[2] NICE CKS – UTI (lower) – women