How Efficient can we Treat Presumed Acute Uncomplicated Lower Urinary Tract Infection in Women with 3-Day Antibiotic in the Accident & Emergency Department?

Abstract

Introduction Urinary tract infection is a common problem in females encountered in the Accident & Emergency Department. The increasing prevalence of Escherichia coli and other urine isolates resistant to trimethoprim-sulfamethoxazole and ampicillin enhances the use of nitrofurantoin as the first line therapy. A guideline of 3-day antibiotic in presumed uncomplicated cystitis has been proved to be of improved cost-effectiveness. Objective To study the outcome and efficiency of 3-day antibiotic treatment in presumed acute uncomplicated cystitis in women in the Accident & Emergency Department. Methods This was a prospective study on women aged 18–55 years with presumed uncomplicated cystitis from January to June 2004. A telephone survey was conducted to assess the clinical response, adverse effect and compliance of the treatment. Results Initially 83 patients were recruited in the study, but only 76 patients' outcomes could be traced by telephone survey and the computer system in public hospitals. Fifty-eight patients (76.3%) had good clinical response with symptoms resolved usually on day 2. Though 48.1% of the patients reported side effects with mainly gastrointestinal discomfort, most were mild and tolerable. The overall compliance was above 80%. Conclusion Three-day nitrofurantoin is an effective, inexpensive treatment for acute uncomplicated cystitis, which is a common disorder in females. Guidelines on the management of this large group of patients would help to conserve health care costs, improve compliance and reduce the emergence of resistance strains.