Clinical Question: Do antibiotics d...

Clinical Question: Do antibiotics decrease symptoms in women with dysuria and oftenness who have a negative dipstick criterion result for nitrites and leukocytes?

Setting: Outpatient (primary care)

contemplation Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: The authors invited women 16 to 50 years of age to participate in this investigation if they presented to their of the present day Zealand general practitioner with a history of dysuria and oftenness but with a midstream urine specimen that was negative for nitrites and leukocyte using standard urine dipstick analysis. As a check upon the validity of the dipstick, urine specimens also were cultur although the be deriveds were not known until after the treatment and assessment had been complet The 59 participants were randomized to receive placebo or trimethoprim (Proloprim) in a dosage of 300 mg daily for three days.

At the extreme point of treatment, 76 percent of the women who received trimethoprim had resolution of dysuria compared with 26 percent of women who received placebo (P = 0005) by way of seven days, 90 percent of the treated women had resolution of dysuria compared with 59 percent of women receiving placebo (P = 02) single additional patient had resolution of symptoms on seven days for every four women who received trimethoprim instead of placebo (number indigenceed to treat = 4; 95% confidence interval, 19 to 141) Urinary common occurrence was unaffected by treatment. It was not that the dipstick standard failed to diagnose infection: agriculture of dipstick- negative urine grew organisms in solely five of 59 women; therefore, the negative predictive value of the dipstick analysis was 92 percent

Bottom Line: In women with dysuria and commonness who have a negative flow on urine dipstick analysis for nitrites and leukocyte three of each four will respond to antibiotic treatment compared with the same in four who are taking placebo. In this thought the negative dipstick result correlated with improvement 92 percent of the time. These rises imply that some women have microbial infections that are not identified by way of dipstick or culture, or perhaps that the antibiotic is doing something other than killing bacteria. (Level of Evidence: 1b)

ALLEN F SHAUGHNESSY, PHARM.D.

cogitation Reference: Richards D, et al. answer to antibiotics of women with symptoms of urinary tract infection yet negative dipstick urine test results: double blind ran-domised controll trial. BMJ July 16 2005;331:143-6

Used with permission from Shaughnessy AF. Treating negative dipstick dysuria decreases symptoms. Accessed online August 22 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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