title: Management of urinary tract infections in female general practice patients.
abstract: BACKGROUND
  Though guidelines for the management of urinary tract infections (UTI) exist in several European countries, little is known about GPs' adherence, and the appropriateness of their management with regard to antibiotic resistance.
  
  
  OBJECTIVE
  To describe German GPs' management of female patients with symptoms of UTI, to assess the diagnostic accuracy of dipsticks in a German general practice setting, to develop diagnostic prediction rules for culture-confirmed UTI, and to compare the adequacy of empirical treatment strategies and GPs' actual prescriptions.
  
  
  METHODS
  In 36 (of 118 invited) teaching general practices, urine cultures and resistance testing were performed during 4 months on all symptomatic patients. GPs completed a questionnaire on each patients' symptoms, risk factors and treatment. Adequacy of different treatment approaches was calculated based on culture results.
  
  
  RESULTS
  445 adult women (76% of all patients) were included, with a median age of 53 years. Complicating factors were present in 27%. Urine culture revealed UTI in 77%. GPs' diagnostic accuracy, using both dipsticks and clinical impressions, was low. A positive nitrite test, dysuria and older age were the only predictive factors of culture-confirmed UTI, however the negative predictive value of dipsticks is low (35%). Empirical treatment of all symptomatic patients with either nitrofurantoin or fluoroquinolones would result in a higher rate of appropriate therapies than the individualized approach chosen by the GPs.
  
  
  CONCLUSIONS
  Most patients with urinary symptoms were not treated according to current guidelines, and GPs' diagnostic and therapeutic accuracy was low. Empirical treatment of all symptomatic patients is probably the most effective policy, but implies unnecessary antibiotic prescriptions.
authors.affiliation: Institute for Microbiology and Infectiology, Mahlower Str. 24, 12049 Berlin, Germany. ehummer@gwdg.de
authors.forename: Eva
authors.initials: E
authors.lastname: Hummers-Pradier
authors.forename: Ann Marit
authors.initials: AM
authors.lastname: Ohse
authors.forename: Matthias
authors.initials: M
authors.lastname: Koch
authors.forename: Wolfgang R
authors.initials: WR
authors.lastname: Heizmann
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kochen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005194:Family Practice; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents; D011933:Reagent Kits, Diagnostic