Treating cystitis – how difficult can it be?*
Treating women with cystitis seems fairly straightforward. Unlike many conditions. in women who attend with cystitis bacterial infection is likely to be present and treating women who complain of symptoms alone is cost effective.
However treating on the basis of symptoms alone would mean that 10% of our adult female patients would receive antibiotics each year. Is there a better way of doing this and as the boys on *Top Gear say – how difficult can it be?
In the BMJ this week is an editorial and three linked research papers which have investigated how best to manage individual patients and how to reduce the number of antibiotics GPs prescribe. The conclusions of these papers are however unclear.
The use of MSU is unhelpful and expensive (if you delay prescribing till you get the result of an MSU women have more symptoms). Beyond this the best next approach is unclear. Prescribing based on patients symptoms, or a delayed prescription (that is advising women to start antibiotics if their symptoms have not settled in two days) or dipstick guided delayed prescription all reduce the number of antibiotic prescriptions used but delaying antibiotics by two or more day’s increases the risk of severe symptoms that will be prolonged.
One insight from the papers is that if their initial symptoms are severe or if they have had cystitis before they are likely to have severe symptoms for a least three days.
At the end of reading these papers I am still confused as to what is the evidence based best approach (we are we told living in a NHS which strives to be evidence based). Clearly more research is needed but till then:
• MSUs are a waste of time and money
• If women have severe symptoms or have had cystitis before then early antibiotic prescription is indicated
• If women have not had cystitis before then a delayed prescription would be a reasonable alternative
Easy then!
However treating on the basis of symptoms alone would mean that 10% of our adult female patients would receive antibiotics each year. Is there a better way of doing this and as the boys on *Top Gear say – how difficult can it be?
In the BMJ this week is an editorial and three linked research papers which have investigated how best to manage individual patients and how to reduce the number of antibiotics GPs prescribe. The conclusions of these papers are however unclear.
The use of MSU is unhelpful and expensive (if you delay prescribing till you get the result of an MSU women have more symptoms). Beyond this the best next approach is unclear. Prescribing based on patients symptoms, or a delayed prescription (that is advising women to start antibiotics if their symptoms have not settled in two days) or dipstick guided delayed prescription all reduce the number of antibiotic prescriptions used but delaying antibiotics by two or more day’s increases the risk of severe symptoms that will be prolonged.
One insight from the papers is that if their initial symptoms are severe or if they have had cystitis before they are likely to have severe symptoms for a least three days.
At the end of reading these papers I am still confused as to what is the evidence based best approach (we are we told living in a NHS which strives to be evidence based). Clearly more research is needed but till then:
• MSUs are a waste of time and money
• If women have severe symptoms or have had cystitis before then early antibiotic prescription is indicated
• If women have not had cystitis before then a delayed prescription would be a reasonable alternative
Easy then!
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