Per Grinsted

Randomised, double blind, placebo controlled trial of penicillin V in the treatment of acute maxillary sinusitis in adults in general practice

Objective - To compare the effectiveness of penicillin V with placebo in the treatment of adult patients with acute maxillary sinusitis in general practice. Design - Randomised, double blind, placebo controlled trial. Setting - 26 Danish general practices. Patients - 133 adult patients with a clinical diagnosis of acute maxillary sinusitis based on maxillary pain and raised values of either C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). Main outcome measures - Pain score and illness score as well as measurement of CRP and ESR values after initiation of treatment. Results - Penicillin V led to a better recovery than did placebo. The difference was statistically significant 3 days after the initiation of treatment with regard to pain reduction, whereas no significant difference was found with regard to the reduction in the sense of illness. At the end of the study, significantly more patients in the penicillin group were completely free of pain compared to the placebo group. This difference was only found in patients with an initial pain score of more than three. The cure rate was 71% in the penicillin group and 37% in the placebo group. Significantly more patients achieved normal CRP values when treated with penicillin (88%) as opposed to placebo (75%). Conclusion - Penicillin V is more effective than placebo in the treatment of acute maxillary sinusitis in adults in general practice, but only in patients with pronounced pain.OBJECTIVE To compare the effectiveness of penicillin V with placebo in the treatment of adult patients with acute maxillary sinusitis in general practice. DESIGN Randomised, double blind, placebo controlled trial. SETTING 26 Danish general practices. PATIENTS 133 adult patients with a clinical diagnosis of acute maxillary sinusitis based on maxillary pain and raised values of either C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). MAIN OUTCOME MEASURES Pain score and illness score as well as measurement of CRP and ESR values after initiation of treatment. RESULTS Penicillin V led to a better recovery than did placebo. The difference was statistically significant 3 days after the initiation of treatment with regard to pain reduction, whereas no significant difference was found with regard to the reduction in the sense of illness. At the end of the study, significantly more patients in the penicillin group were completely free of pain compared to the placebo group. This difference was only found in patients with an initial pain score of more than three. The cure rate was 71% in the penicillin group and 37% in the placebo group. Significantly more patients achieved normal CRP values when treated with penicillin (88%) as opposed to placebo (75%). CONCLUSION Penicillin V is more effective than placebo in the treatment of acute maxillary sinusitis in adults in general practice, but only in patients with pronounced pain.

Pivmecillinam versus sulfamethizole for short-term treatment of uncomplicated acute cystitis in general practice: A randomized controlled trial

Objective. To investigate whether short-term treatment with pivmecillinam was more effective than sulfamethizole in patients with acute uncomplicated urinary tract infection (UTI). Design. Randomized controlled trial. Setting. General practice, Denmark. Subjects. Patients (n = 167) with uncomplicated UTI confirmed by positive urine phase-contrast microscopy. Main outcome measures. Drug efficacy based on clinical and bacteriological cure. Results. Urinary symptoms disappeared first in patients treated with pivmecillinam, but after five days there was no significant difference in clinical cure rate between the two antibiotics. At the follow-up visit 7–10 days after initiation of treatment, 95.4% of patients treated with pivmecillinam and 92.6% of patients treated with sulfamethizole had no persistent cystitis symptoms (difference 2.8%, CI −4.5%; 10.0%). Bacteriological cure was observed in 68.8% of patients randomized to pivmecillinam and in 77.9% randomized to sulfamethizole (difference −9.2%, CI −24.7%; 6.3%). Some 26.8% of patients randomized to pivmecillinam experienced a new UTI within 6 months after treatment compared with 18.4% of patients randomized to sulfamethizole (difference 8.4%, CI −4.5%;21.4%). No patients developed septicaemia with urinary pathogens within one year after initial treatment. Conclusion. Patients treated with a three-day regime of pivmecillinam experienced faster relief of symptoms compared with patients treated with a three-day regime of sulfamethizole. Five days after initiation of treatment there was no significant difference in clinical and bacteriological cure between the two antibiotic regimes.

Standardised procedures can improve the validity of susceptibility testing of uropathogenic bacteria in general practice

Objective - To investigate whether the validity of susceptibility testing in general practice would improve when preceded by an intervention. Intervention - Instruction in standardised susceptibility testing procedures given by laboratory instructors. Method - Urine specimens containing monocultures of typical uropathogenic bacteria were sent to 23 general practices before and after the intervention. Practices performed susceptibility testing by the Sensicult and the Iso-Res agar methods and the validity of the results before and after the intervention was compared. Results from susceptibility testing at the bacteriological laboratory, Odense University Hospital, were used as gold standard. Results ? The median frequency of correct results increased from 82% to 98% for susceptibility testing based on Sensicult (p = 0.001) and from 90% to 96% based on Iso-Res agar (p = 0.05). Conclusion ? The validity of susceptibility testing in general practice improves when preceded by instruction in standardised procedures.

Detection of bacteriuria by microscopy and dipslide culture in general practice

Background: Patients presenting with symptoms of urinary tract infections account for 2-5% of contacts in general practice, but only about half of them have significant bacteriuria. A definite diagnosis depends on a microbiological test demonstrating a significant number of bacteria. In general practice the diagnosis is often reached by a microscopic analysis or a dipslide culture test. Only a few studies have looked at the validity of urine examinations when performed in general practice, and the results are diverging. We need more knowledge about the validity of tests for detection of uropathogenic bacteria in general practice. Aim: To validate detection of bacteriuria by urine microscopy and dipslide culture in general practice. Method: Urine specimens with a known quantity of bacteria (Escherichia coli, Proteus mirabilis, Enterobacter cloacae, Staphylococcus epidermidis and Enterococcus faecalis) were sent to 25 general practices for microscopic examination and dipslide culture. No prior instruction in testing procedure was given. The results of a standardised culture method performed by skilled bacteriologists at the bacteriological laboratory were used as gold standard. Results: Significant bacteriuria was identified by microscopy with a sensitivity of 95% and a specificity of 83%. The corresponding figures for urine culture were 95% and 96%, respectively. The morphology of bacteria was interpreted correctly in 80% of microscopic examinations, and 60% of the bacteria strains were classified correctly concerning their motility. Conclusion: Microscopy and dipslide are valid methods for detecting significant bacteriuria in general practice.