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Urinary tract infection in primary care

BMJ 2007; 334 doi: (Published 22 March 2007) Cite this as: BMJ 2007;334:597
  1. Dee Mangin, senior lecturer (,
  2. Les Toop, professor
  1. Department of Public Health and General Practice, Christchurch School of Medicine, University of Otago, New Zealand

    Recommendations for first line treatment should be informed by clinical and microbiological data

    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 interesting from a primary care perspective is the low absolute reconsultation rate in the subsequent week in the resistant group (39%). In other words 61% of women with resistant organisms did not reconsult in the subsequent week because of treatment …

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