A randomized controlled trial of a diagnostic algorithm for symptoms of uncomplicated cystitis at an out-of-hours service

Marianne Bollestad, Nils Grude, Morten Lindbaek, Marianne Bollestad, Nils Grude, Morten Lindbaek

Abstract

Objective: To compare the clinical outcome of patients presenting with symptoms of uncomplicated cystitis who were seen by a doctor, with patients who were given treatment following a diagnostic algorithm.

Design: Randomized controlled trial.

Setting: Out-of-hours service, Oslo, Norway.

Intervention: Women with typical symptoms of uncomplicated cystitis were included in the trial in the time period September 2010-November 2011. They were randomized into two groups. One group received standard treatment according to the diagnostic algorithm, the other group received treatment after a regular consultation by a doctor.

Subjects: Women (n = 441) aged 16-55 years. Mean age in both groups 27 years.

Main outcome measures: Number of days until symptomatic resolution.

Results: No significant differences were found between the groups in the basic patient demographics, severity of symptoms, or percentage of urine samples with single culture growth. A median of three days until symptomatic resolution was found in both groups. By day four 79% in the algorithm group and 72% in the regular consultation group were free of symptoms (p = 0.09). The number of patients who contacted a doctor again in the follow-up period and received alternative antibiotic treatment was insignificantly higher (p = 0.08) after regular consultation than after treatment according to the diagnostic algorithm. There were no cases of severe pyelonephritis or hospital admissions during the follow-up period.

Conclusion: Using a diagnostic algorithm is a safe and efficient method for treating women with symptoms of uncomplicated cystitis at an out-of-hours service. This simplification of treatment strategy can lead to a more rational use of consultation time and a stricter adherence to National Antibiotic Guidelines for a common disorder.

Trial registration: ClinicalTrials.gov NCT01132131.

Keywords: After-hours care; Norway; algorithms; amdinocillin (mecillinam); general practice; primary health care; urinary tract infection.

Figures

Figure 1.
Figure 1.
Diagnostic algorithm.
Figure 2.
Figure 2.
Trial flow chart: RCT of diagnostic algorithm for uncomplicated cystitis at an Out-of-hours service in Oslo, Norway.
Figure 3.
Figure 3.
Symptom resolution: Percentage of patients with remaining symptoms versus number of days since the start of treatment, Kaplan–Meier plot. Blue line: Treated according to the diagnostic algorithm. Green line: Treatment chosen after a doctor's consultation. P-value (log rank): 0.3.

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Source: PubMed

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