title: A randomized controlled trial of a diagnostic algorithm for symptoms of uncomplicated cystitis at an out-of-hours service.
abstract: OBJECTIVE
  To compare the clinical outcome of patients presenting with symptoms of uncomplicated cystitis who were seen by a doctor, with patients who were given treatment following a diagnostic algorithm.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Out-of-hours service, Oslo, Norway.
  
  
  METHODS
  Women with typical symptoms of uncomplicated cystitis were included in the trial in the time period September 2010-November 2011. They were randomized into two groups. One group received standard treatment according to the diagnostic algorithm, the other group received treatment after a regular consultation by a doctor.
  
  
  METHODS
  Women (n = 441) aged 16-55 years. Mean age in both groups 27 years.
  
  
  METHODS
  Number of days until symptomatic resolution.
  
  
  RESULTS
  No significant differences were found between the groups in the basic patient demographics, severity of symptoms, or percentage of urine samples with single culture growth. A median of three days until symptomatic resolution was found in both groups. By day four 79% in the algorithm group and 72% in the regular consultation group were free of symptoms (p = 0.09). The number of patients who contacted a doctor again in the follow-up period and received alternative antibiotic treatment was insignificantly higher (p = 0.08) after regular consultation than after treatment according to the diagnostic algorithm. There were no cases of severe pyelonephritis or hospital admissions during the follow-up period.
  
  
  CONCLUSIONS
  Using a diagnostic algorithm is a safe and efficient method for treating women with symptoms of uncomplicated cystitis at an out-of-hours service. This simplification of treatment strategy can lead to a more rational use of consultation time and a stricter adherence to National Antibiotic Guidelines for a common disorder.
authors.affiliation: Out-of-hours Service , Oslo Municipality Norway , Norway.
authors.forename: Marianne
authors.initials: M
authors.lastname: Bollestad
authors.forename: Nils
authors.initials: N
authors.lastname: Grude
authors.forename: Morten
authors.initials: M
authors.lastname: Lindbaek
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000379:methods*; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003556:Cystitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D019983:Guideline Adherence; D006296:Health Services; D006801:Humans; D008875:Middle Aged; D009664:Norway; D009819:Office Visits; D010820:Physicians; D011320:Primary Health Care; D011704:Pyelonephritis / Q000517:prevention & control; D012017:Referral and Consultation; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: After-hours care; Norway; algorithms; amdinocillin (mecillinam); general practice; primary health care; urinary tract infection