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Background: Despite the considerable morbidity caused by recurrent urinary tract infections (rUTIs), and the wider personal and public health implications from frequent antibiotic use, few studies adequately describe the prevalence and characteristics of women with rUTIs or those who use prophylactic antibiotics. Aim: To describe the prevalence, characteristics, and urine profiles of women with rUTIs with and without prophylactic antibiotic use in Welsh primary care. Design and setting: This was a retrospective cross-sectional study in Welsh general practice using the Secure Anonymised Information Linkage (SAIL) Databank. Method: The characteristics of women aged ≥18 years with rUTIs or using prophylactic antibiotics from 2010 to 2020, and associated urine culture results from 2015 to 2020, are described. Results: In total, 6.0% (n = 92 213/N = 1 547 919) had rUTIs, and 1.7% (n = 26 862/N = 1 547 919) were prescribed prophylactic antibiotics with the rates increasing after 57 years of age. Only 49.0% (n =13 149/N = 26 862) of users of prophylactic antibiotics met the definition of rUTIs before initiation. The study found that 80.8% (n = 44 947/N = 55 652) of women with rUTIs had a urine culture result in the preceding 12 months with high rates of resistance to trimethoprim and amoxicillin. Of women taking prophylactic antibiotics, 64.2% (n = 9926/N = 15 455) had a urine culture result before initiation and 18.5% (n = 320/N = 1730) of women prescribed trimethoprim had resistance to it on the antecedent sample. Conclusion: A substantial proportion of women had rUTIs or incident prophylactic antibiotic use. However, 64.2% (n = 9926/N = 15 455) of women had urine cultured before starting prophylaxis. There was a high proportion of cultured bacteria resistant to two antibiotics used for rUTI prevention and evidence of resistance to the prescribed antibiotic. More frequent urine cultures for rUTI diagnosis and before prophylactic antibiotic initiation could better inform antibiotic choices. [ABSTRACT FROM AUTHOR]

Background: The cost-effectiveness of molnupiravir, an oral antiviral for early treatment of SARS-CoV-2, has not been established in vaccinated populations. Aim: To evaluate the cost-effectiveness of molnupiravir relative to usual care alone among mainly vaccinated community-based people at higher risk of severe outcomes from COVID-19 over 6 months. Design and setting: An economic evaluation of the PANORAMIC trial in the UK. Method: A cost-utility analysis that adopted a UK NHS and personal social services perspective and a 6-month time horizon was performed using PANORAMIC trial data. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity and subgroup analyses assessed the impacts of uncertainty and heterogeneity. Threshold analysis explored the price for molnupiravir consistent with likely reimbursement. Results: In the base-case analysis, molnupiravir had higher mean costs of £449 (95% confidence interval [CI] = 445 to 453) and higher mean QALYs of 0.0055 (95% CI = 0.0044 to 0.0067) than usual care (mean incremental cost per QALY of £81 190). Sensitivity and subgroup analyses showed similar results, except for those aged ≥75 years, with a 55% probability of being cost-effective at a £30 000 per QALY threshold. Molnupiravir would have to be priced around £147 per course to be cost-effective at a £15 000 per QALY threshold. Conclusion: At the current cost of £513 per course, molnupiravir is unlikely to be cost-effective relative to usual care over a 6-month time horizon among mainly vaccinated patients with COVID-19 at increased risk of adverse outcomes, except those aged ≥75 years. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infection (UTI) is one of the commonest bacterial infections in general practice, with urine testing a frequent feature of its management. Urinary dipsticks are widely used, with urine culture the reference standard test. To avoid contamination, patients are advised to discard the first part of the urine stream, retaining the midstream part for the sample. This process, however, can be challenging both to explain and to perform. There is a lack of literature investigating women's perceptions and understanding of urine sampling.Aim: To explore women's understanding of urine collection, sample contamination, and how information from samples informed UTI management.Design and Setting: Qualitative study embedded in a UK randomised controlled trial (RCT) of urinary collection devices (UCDs) among women attending primary care with a suspected UTI.Method: Semi-structured telephone interviews were conducted with 29 women participating in the RCT. Interviews were transcribed and thematically analysed.Results: Participants were not always aware about what midstream samples were and why they were preferable. They also lacked understanding about how urine samples may be contaminated, and sources of contamination. Participants experienced variability in the information received following analysis of their sample.Conclusion: Provision of clear information could help provide better urine samples, aiding the diagnosis of UTIs, presenting results with greater clarity, and creating less need for repeat samples. Sharing of information derived from uncontaminated samples may also support better UTI management, helping to reduce unnecessary prescribing and antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background: Urine collection devices (UCDs) are being marketed and used in clinical settings to reduce urine sample contamination, despite inadequate supporting evidence.Aim: To determine whether UCDs, compared with standardised instructions for urine sample collection, reduce the proportion of contaminated samples.Design and Setting: Single-blind randomised controlled trial in general practices in England and Wales.Method: Women aged ≥18 years presenting with symptoms attributable to urinary tract infection (UTI) were randomised (1:1:1) to use either a Peezy UCD or a Whiz Midstream UCD, or were given standardised verbal instructions (SVI) for midstream sample collection. The primary outcome was the proportion of urine samples reported as contaminated by microbiology laboratory analysis.Results: A total of 1264 women (Peezy UCD: n = 424; Whiz Midstream UCD: n = 421; SVI: n = 419) were randomised between October 2016 and August 2018. Ninety women were excluded from the primary analysis as a result of ineligibility or lack of primary outcome data, leaving 1174 (Peezy UCD: n = 381; Whiz Midstream UCD: n = 390; SVI: n = 403) for intention-to-treat analysis. The proportion of contaminated samples was 26.5% with the Peezy UCD, 28.2% with the Whiz Midstream UCD, and 29.0% with SVI (relative risk: Peezy UCD versus SVI = 0.91, 95% CI = 0.76 to 1.09, P = 0.32; Whiz Midstream UCD versus SVI = 0.98, 95% CI = 0.97 to 1.20, P = 0.82). There were 100 (25.3%) device failures with the Peezy UCD and 35 (8.8%) with the Whiz Midstream UCD; the proportion of contaminated samples was similar after device failure samples were excluded.Conclusion: Neither the Peezy UCD nor the Whiz Midstream UCD reduced urine sample contamination when used by women presenting to primary care with suspected UTI. Their use cannot be recommended for this purpose in this setting. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections (UTIs) affect around 20% of the male population in their lifetime. The incidence of UTIs in men in the community is 0.9–2.4 cases per 1000 aged <55 years and 7.7 per 1000 aged ≥85 years. Aim: To evaluate the outcomes of randomised controlled trials (RCTs) comparing the effectiveness of different antimicrobial treatments and durations for uncomplicated UTIs in adult males in outpatient settings. Method: A systematic literature review of RCTs of adult male patients with an uncomplicated UTI treated with oral antimicrobials in any outpatient setting. The outcomes were symptom resolution within 2 weeks of starting treatment, duration until symptom resolution, clinical cure, bacteriological cure, and frequency of adverse events. Results: From the 1052 abstracts screened, three provided sufficient information on outcomes. One study compared trimethoprim-sulfamethoxazole for 14 days (21 males) with 42 days (21 males). Fluoroquinolones were compared in the two other RCTs: lomefloxacin (10 males) with norfloxacin (11 males), and ciprofloxacin for 7 days (19 males) and 14 days (19 males). Combining the results from the three RCTs shows that for 75% males with a UTI (76/101) bacteriological cure was reported at the end of the study. Of the 59 patients receiving a fluoroquinolone, 57 (97%) reported bacteriological and clinical cure within 2 weeks after treatment. Conclusion: The evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs. Sufficiently powered RCTs are needed to identify best treatment type and duration for male UTIs in primary care. [ABSTRACT FROM AUTHOR]

Background: Children with respiratory tract infections (RTIs) use more primary care appointments than any other group, but many parents are unsure if, and when, they should seek medical help and report that existing guidance is unclear.Aim: To develop symptom-based criteria to support parental medical help seeking for children with RTIs.Design and Setting: A research and development/University of California Los Angeles (RAND/UCLA) appropriateness study to obtain consensus on children's RTI symptoms appropriate for home, primary, or secondary health care in the UK.Method: A multidisciplinary panel of 12 healthcare professionals - six GPs, two pharmacists, two NHS 111 nurses, and two emergency paediatric consultants - rated the appropriateness of care setting for 1134 scenarios in children aged >12 months.Results: Panellists agreed that home care would be appropriate for children with ≤1 week of 'normal' infection symptoms (cough, sore throat, ear pain, and/or runny nose, with or without eating adequately and normal conscious level). The presence of ≥2 additional symptoms generally indicated the need for a same-day GP consultation, as did the presence of shortness of breath. Assessment in the emergency department was considered appropriate when ≥3 symptoms were present and included shortness of breath or wheezing.Conclusion: The authors have defined the RTI symptoms that parents might regard as 'normal' and therefore suitable for care at home. These results could help parents decide when to home care and when to seek medical help for children with RTIs. [ABSTRACT FROM AUTHOR]

Background: Accurate assessment of the need for admission is challenging in out-of-hours (OOH) primary care. Understanding more about patient contacts where the decision to continue care in the community may have been incorrect could assist clinicians in assessing clinical risk.Aim: To define the population contacting OOH primary care who are at higher risk of re-presenting to this service and requiring urgent transfer to secondary care within 3 days of their initial contact.Design and Setting: Retrospective service evaluation of 4 years of patient contacts with Oxfordshire OOH primary care.Method: Multivariable logistic regression was used to evaluate demographic and service delivery factors associated with increased risk of delayed escalation to secondary care.Results: Almost 1% of 496 931 patients contacting OOH primary care required escalation to secondary care within 3 days. Of these, 68.5% were initially discharged with no follow-up or advice to contact their GP; 14.7% were initially referred to secondary care. The odds of requiring escalation were increased with age (odds ratio [OR] 1.010; 95% confidence interval [CI] = 1.009 to 1.011; P<0.001), more frequent prior use of the OOH service (OR 1.016; 95% CI = 1.010 to 1.021; P<0.001), and presenting during periods of low call volume (OR 0.880; 95% CI = 0.857 to 0.904; P<0.001).Conclusion: Older, prior users of the service, presenting at less busy times, are at greater risk of requiring secondary care referral from the OOH service within 3 days of their initial contact. These higher-risk patient groups might benefit from active follow-up by the OOH service. [ABSTRACT FROM AUTHOR]

The article provides an answer to the question of what is the accuracy and utility of point-of-care testing compared with existing technology in detecting Helicobacter pylori infection?

Background: UK general practice surgeries collect data regarding patient ethnicities, typically at registration. These data are subsequently used in both clinical care and research, for example, when embedded in risk modelling tools. The published standard list of ethnic categories exists, but little is known about what happens in frontline practice., Aim: To document the variation in ethnic categories available on online patient registration forms across GP surgeries in Oxfordshire., Method: Of all 67 GP surgeries in Oxfordshire, 56 had online registration forms that included an option list for ethnicity reporting. The authors compared these against the 2001, 2011, and 2021 UK census ethnic group categorisation., Results: Significant heterogeneity was identified across practices. The number of options for ethnicity group ranged from 5 to 84, with a median of 14, compared to the census lists that comprise of 19 (2021), 18 (2011), and 16 (2001) groups. Of the 56 practices, six used the 2001 census list, five used the 2011 census list, and none used the 2021 census list. Overall, 45 practices used lists that differed from any census list, including categories not typically considered to be ethnic, for example 'Muslim' or 'Buddhist', meaning individuals could potentially identify with multiple options., Conclusion: High-quality research and healthcare data that includes patient ethnicity is essential to understand, document, and mitigate against health inequalities. However, this may be compromised by poorly conceived ethnic categorisations and a lack of standardisation. This pilot/exploratory study suggests that the ethnicity records in primary health care may be neither standardised nor meaningful., (© British Journal of General Practice 2024.)