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 Cochrane review: 3days treatment for uncomplicated utis in non pregnant women aged yrs achieves symptomatic cure.Consider 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 mg 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 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 =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