Obravnava bolnic z nezapleteno okužbo sečil v družinski medicini

Izhodišča: Nezapletena okužba sečil je ena najpogostejših bakterijskih bolezni, s katerimi se srečuje zdravnik družinske medicine. Namen raziskave je bil ugotoviti, kako to bolezen obravnavajo in v kolikšni meri upoštevajo nacionalna priporočila za uporabo trimetoprim-sulfometoksazola kot zdravila prve izbire. Bolniki in metode: Raziskava je zasnovana na presečni študiji dela slovenskih zdravnikov družinske medicine. Vanjo je bilo zajetih 42 naključno izbranih zdravnikov družinske medicine, ki so v času od 1. oktobra 2003 do 31. marca 2004 beležili obiske v svojih ambulantah in izpolnjevali vprašalnik o svojem delu. Od 12.596 zabeleženih stikov jih je 64 ustrezalo pogojem za uvrstitev v končni vzorec žensk, starih od 18 do 65 let, z ugotovljeno nezapleteno okužbo sečil. Obrazec je vključeval podatke o spolu, starosti in izobrazbi bolnic, razlogu za obisk, diagnostične in terapevtske postopke, diagnoze in odobritev bolniškega staleža ter morda naročeni kontrolni pregled. Zdravniki so merili tudi trajanje obiska. V vzorec so se uvrstile ženske v starosti med 18 in 65 leti z diagnosticirano nezapleteno okužbo spodnjih sečil (64 bolnic). Rezultati: 64 od 4388 bolnic v starostni 18do 65 let (1,5 %) je imelo nezapleteno okužbo sečil. Povprečni obisk bolnic z nezapleteno okužbo sečil je trajal 7,6 min. Pri 53,1 % bolnicah so zdravniki postavili diagnozo na podlagi anamneze in morebitnega pregleda urina brez urinokulture. Trimetoprim- sulfometoksazol (TMA +SMA) je bil kot zdravilo prve izbire predpisan pri 71,9 % bolnic. 60,9 % bolnic je bilo naročenih na ponovno kontrolo v povprečju čez 7,7 dni, 20,3 % bolnic je zaradi nezapletene okužbe sečil koristilo bolniški stalež. Ustrezno spremljanje, ki ne zahteva kontrolnega pregleda in bolniškega staleža je bilo prisotno pri 16 (25,0 %) bolnicah. Zaključki: V primerjavi z nekaterimi državami se slovenski zdravniki v zelo visokem odstotku držijo priporočil za antimikrobno zdravljenje nezapletenih okužb sečil, vendar pa se prepogosto odločajo za pregled urinskih vzorcev, kontrolni pregled in bolniški stalež. Možnost izboljšav se nakazuje v prihodnjem izogibanju nepotrebnim pregledom urinskih vzorcev, ponovnim obiskom v ambulanti in predpisovanju bolniškega staleža.Background: Acute cystitis is one of the most common bacterial infections encountered in family physician\u27s office. The aim of this study was to highlight some aspects of managing this infection and to survey the adherence of Slovenian physicians to the national recommendations for using trimethoprim-sulphmetoxazole as a first-line drug. Methods: The study was based on a cross-sectional study of Slovene family physicians\u27 performance. A random sample of 42 physicians participated in the survey. The study took place between 1 October 2003 and 31March 2004.In total, 12,596 contacts were registered. The physicians were asked to fill in the questionnaire for each patient-doctor encounter. The questionnaire included patient data (sex, age, educational level), reason for the visit, diagnostic and therapeutic procedures, diagnoses, number of days away from work and a possible follow-up visit. The physicians were also instructed to measure the duration of each visit. Eligible visits were limited to those by women aged 18 to 65 years diagnosed with uncomplicated acute cystitis or urinary tract infection (N= 64). Results: Sixty-four out of 4,388 of women aged 18 to 65 years presented with uncomplicated urinary tract infection.The visit of a patient with uncomplicated urinary tract infection lasted 7.6 minutes. In 53.1 % of cases the diagnosis was based on history, physical examination and urine sample testing without obtaining urine culture. In 71.9 % of cases trimethoprim-sulphametoxasol was prescribed as first-line therapy. A total of 60.9 % of the patients were scheduled for a follow-up visit in a mean time of 7.7 days. Sick-leave was prescribed to 20.3 % of the patients, and only 16 (25%) of the patients had appropriate follow-up requiring no sick-leave or follow-up visits. Conclusions: Adherence of Slovene family physicians to the current guidelines for antibiotic therapy in uncomplicated lower urinary tract infections is surprisingly high compared to some other countries, yet therate of urine analyses, follow-up visits and sick-leaves in these patients is too high. In the future, the situation can be improved by avoiding unnecessary testing, follow-up visits and sick-leaves