Transcript Practice based audit of 3-day treatment for uncomplicated cystitis

Practice based audit of 3-day
treatment for uncomplicated
cystitis
The Evidence
• Uncomplicated utis are usually self-limiting and
spontaneously resolve in a few days.MeReC
Bulletin 2006.
• Cochrane review: 3days treatment for
uncomplicated utis in non pregnant women aged
18-65 yrs achieves symptomatic cure.Consider 510 days in whom eradication bacteruria is
important(recurrent utis,planning pregnancy),renal
angle pain,fever,rigors etc.
3 day regimes-first line
• Trimethoprim 200mg bd Notes:resistance
increases with age.
• Nitrofurantoin 50-100mg qds Notes:avoid if
eGFR <60 because of inadequate urine
concentrations and concominant use
alkalinising agents.
What do we do?
Practice based audit of uncomplicated utis in women
aged 18-65
Suggested standard:95% could be treated with 3 days
of an appropriate antibiotic
Methodology:data on prescriptions for 1 commonly
prescribed first line treatment( trimethoprim) were
collected over a 2 month period.Those with
symptoms/history/urine culture suggesting
complicated infections were excluded.
Results
• Total no.women with uncomplicated uti
aged 18-65 =24
• 3 days treatment 1
• 5 days treatment 22
• 7 days treatment 1
Conclusions
• Current NICE /SIGN guidance suggests 22
women could have been treated with 2 days fewer
trimethoprim
• Possible benefits incl.fewer side-effects,better
compliance and a small reduction in cost
• Implementing 3 day- regimes would need patient
education and alteration of prescription details if
the antibiotic is‘reinstated' from drug history
screen
Change?
• Disseminate findings to those seeing
women with uncomplicated uti;and discuss
possible changes
• Re-audit in 6 months