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Urinary Tract Infections And Antibiotic Resistance

Urinary Tract Infections And Antibiotic Resistance In The Community

Novel research results by the Christchurch School of Medicine and Health Sciences, Otago University, shows how difficult it can be for GPs to decide whether or not to prescribe antibiotics for common symptoms of Urinary Tract Infections (UTI) in women. GPs have become wary about over prescribing antibiotics in order to avoid encouraging antibiotic resistance, which is a growing clinical problem world-wide.

This latest research, recently published in the prestigious ‘British Medical Journal’, by Dr Dee Richards and colleagues Professors Les Toop and Steve Chambers provides some evidence to help GPs in the dilemma they face; to prescribe antibiotics for UTI symptoms, or not to prescribe?

The study of women in the Christchurch community, in collaboration with Pegasus Health GPs, is the first of its kind in the country. It looked at 59 women who presented with symptoms but a negative dipstick urine test for infection in the surgery, and in subsequent laboratory analysis. These women were then divided randomly in two groups; one group was given the first line antibiotic trimethoprim, while the other was given a placebo.

“It’s a common dilemma for GPs when a woman has symptoms of a UTI, but the standard urine test is negative for bacterial infection. While wanting to relieve the unpleasant symptoms they don’t want to prescribe drugs unnecessarily. A significant proportion of women with symptoms fall into this group “

Interestingly the results show for the first time, that that even though the initial dipstick test indicated they did not have a UTI, the women who took antibiotics recovered more quickly than those who took a placebo. The median time for symptoms to disappear was three days for those on antibiotics, compared to five for those in the placebo group.

“This information is very helpful to GPs in making a decision about whether to prescribe or not. However these results do indicate that further research is needed for those women who test negative for UTIs, to understand why they actually benefited from antibiotics, even though the front-line dipstick test and the subsequent laboratory test indicated they didn’t have a bacterial infection,” says Dr Richards.

She says the results suggest there may be other causes for the UTI symptoms than those picked up by the standard dipstick urine test.

The second area of recent research looked at levels of antibiotic resistance in the Christchurch community using samples of UTIs collected by 76 Pegasus Health GPs who are part of the Christchurch Sentinel GP Network, and then submitting them for laboratory analysis.

“This study suggests the possibility of increasing resistance compared to previous research. Overall we estimate that women with a positive urine test have trimethoprim resistance of 7.4% compared to 2.7% in 2000. However, a third study with more participants, is now required to confirm whether this is a significant trend to increasing resistance to antibiotics.”

Dr Richards says these results demonstrate the importance of monitoring of antibiotic resistance in the community. The Christchurch Sentinel GP Network is the only one in the country performing this surveillance. It has just completed a third study looking at MRSA.

This research has been funded by Pegasus Health, the Health Research Council and the Canterbury Medical Research Foundation .


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