立即登录 | 免费注册
全部学科 | 内科学 | 心血管病学 | 内分泌学与糖尿病 | 神经病学 | 消化病学 | 呼吸病学 | 肿瘤学 | 妇产科学 | 骨科学
疾病中心： 高血压 | 冠心病 | 心力衰竭 | 心律失常 | 脂肪性肝病 | 糖尿病 | 卒中 | 慢性阻塞性肺病 | 子宫内膜异位症 | 乳腺癌 | 肺癌 | 结直肠癌 | 器官移植
Loading
当前位置：期刊中心 > 全球精选文摘 > 文摘导读

5种不同方法治疗尿路感染的疗效：一项随机对照试验

Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial
Little P, Moore MV, Turner S   |    2010/8/19 14:02:24   | 
BMJ  |   2010   |          View at Publisher
专家评级： ★★  |    循证评级： A   |  【全球专家评论】 |   打印| 推荐给好友
上一篇： 护士健康研究：行子宫切除术时保留卵巢与远期健康转归
下一篇： 辅助授精与臀位分娩：风险与产科管理
Objective:
To assess the impact of different management strategies in urinary tract infections.

Design:
Randomised controlled trial.

Setting:
Primary care.

Participants:
309 non-pregnant women aged 18-70 presenting with suspected urinary tract infection.

Intervention:
Patients 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 Measures:
Symptom severity (days 2 to 4) and duration, and use of antibiotics.

Results:
Patients had 3.5days 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).

Conclusion:
All 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.
关键词:

请登录后发表评论，点击此处登录。

慢性心衰诊治：规范中求突破
黄峻
2012-2-1
南京医科大学第一附属医院
房颤治疗：手段渐趋丰富 新型治疗药物不断涌现 非药物治疗备受关注
马长生
2012-2-1
首都医科大学附属北京安贞医院
注重老年人群特征 优化管理

刘梅林
2012-2-1
北京大学第一医院老年内科

 
相关文章