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 informed by 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 colleagues in the Journal of Antimicrobial Chemotherapy reports on 448 women with symptoms of uncomplicated urinary tract infection who were treated with trimethoprim in primary care.1 The aim was to see whether women with infections resistant to trimethoprim had worse clinical outcomes. While the answer might seem intuitive, some of the findings were interesting. Pure bacterial culture was found in 317 women and the rate of resistance to trimethoprim was lower than expected from local laboratory resistance data derived from routinely collected specimens (13.9% v 24.5-27%). Predictably, antibiotic resistance was associated with longer median duration of symptoms (7 v 4 days; P<0.0002), higher frequency of subsequent prescription of antibiotics (36% v 4% in the first week; P<0.0001), and higher rates of reconsultation for treatment failure (39% v 6%; P<0.0001). While this sixfold relative 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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