Urinary tract infection in primary care

doi:10.1136/bmj.39148.403206.80

BMJ 2007;334:597-598 (24 March), doi:10.1136/bmj.39148.403206.80

Editorials

Urinary tract infection in primary care

Recommendations for first line treatment should be informedby clinical and microbiological data

The first 150 words of the full text of this article appear below.

A recent prospective cohort study by McNulty and colleaguesin the Journal of Antimicrobial Chemotherapy reports on 448women with symptoms of uncomplicated urinary tract infectionwho were treated with trimethoprim in primary care.¹ The aimwas to see whether women with infections resistant to trimethoprimhad worse clinical outcomes. While the answer might seem intuitive,some of the findings were interesting. Pure bacterial culturewas found in 317 women and the rate of resistance to trimethoprimwas lower than expected from local laboratory resistance dataderived from routinely collected specimens (13.9% v 24.5-27%).Predictably, antibiotic resistance was associated with longermedian duration of symptoms (7 v 4 days; P<0.0002), higherfrequency of subsequent prescription of antibiotics (36% v 4%in the first week; P<0.0001), and higher rates of reconsultationfor treatment failure (39% v 6%; P<0.0001). While this sixfoldrelative difference in treatment failure rates is impressive,what is . . . [Full text of this article]

Dee Mangin, senior lecturer, Les Toop, professor

Department of Public Health and General Practice, Christchurch School of Medicine, University of Otago, New Zealand

derelie.mangin@chmeds.ac.nz

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