Evidence map›Paper›PMID 20139214›Full record

Trial reportBMJ (Clinical research ed.)2010

Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial.

P Little, M V Moore, S Turner, K Rumsby, G Warner, J A Lowes, H Smith, C Hawke, G Leydon, A Arscott and 2 more

Abstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 99 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
99citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

99 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Guideline
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  5. Screening with urinary dipsticks for reducing morbidity and mortality.The Cochrane database of systematic reviews · 2015
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  16. Predicting antibiotic prescription after symptomatic treatment for urinary tract infection: development of a model using data from an RCT in general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2016
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39 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

P LittlePrimary Care Medical Group, Community Clinical Sciences Division, University of Southampton School of Medicine, Southampton SO16 5ST. p.little@soton.ac.uk
M V Moore
S Turner
K Rumsby
G Warner
J A Lowes
H Smith
C Hawke
G Leydon
A Arscott
D Turner
M Mullee

Funding

Department of Health 97/14/06
6 · The paper itself

Abstract

objectiveTo assess the impact of different management strategies in urinary tract infections.

designRandomised controlled trial.

settingPrimary care.

participants309 non-pregnant women aged 18-70 presenting with suspected urinary tract infection.

interventionPatients were randomised to five management approaches: empirical antibiotics; empirical delayed (by 48 hours) antibiotics; or targeted antibiotics based on a symptom score (two or more of urine cloudiness, urine smell, nocturia, or dysuria), a dipstick result (nitrite or both leucocytes and blood), or a positive result on midstream urine analysis. Self help advice was controlled in each group.

main outcome measuresSymptom severity (days 2 to 4) and duration, and use of antibiotics.

resultsPatients had 3.5 days of moderately bad symptoms if they took antibiotics immediately. There were no significant differences in duration or severity of symptoms (mean frequency of symptoms on a 0 to 6 scale: immediate antibiotics 2.15, midstream urine 2.08, dipstick 1.74, symptom score 1.77, delayed antibiotics 2.11; likelihood ratio test for the five groups P=0.177). There were differences in antibiotic use (immediate antibiotics 97%, midstream urine 81%, dipstick 80%, symptom score 90%, delayed antibiotics 77%; P=0.011) and in sending midstream urine samples (immediate antibiotics 23%, midstream urine 89%, dipstick 36%, symptom score 33%, delayed antibiotics 15%; P<0.001). Patients who waited at least 48 hours to start taking antibiotics reconsulted less (hazard ratio 0.57 (95% confidence interval 0.36 to 0.89), P=0.014) but on average had symptoms for 37% longer than those taking immediate antibiotics (incident rate ratio 1.37 (1.11 to 1.68), P=0.003), particularly the midstream urine group (73% longer, 22% to 140%; none of the other groups had more than 22% longer duration).

conclusionAll management strategies achieve similar symptom control. There is no advantage in routinely sending midstream urine samples for testing, and antibiotics targeted with dipstick tests with a delayed prescription as backup, or empirical delayed prescription, can help to reduce antibiotic use. STUDY REGISTRATION: National Research Register N0484094184 ISRCTN: 03525333.

Indexed as

AdolescentAdultAgedAlgorithmsAnti-Bacterial AgentsFemaleHumansMiddle AgedPamphletsPatient Education as TopicReagent StripsTreatment OutcomeUrinary Tract InfectionsYoung AdultAnti-Bacterial AgentsReagent Strips

Identifiers

PMID20139214
PMCPMC2817051

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.