Showing papers by "Thierry Christiaens published in 2005"
TL;DR: Three days of antibiotic therapy is similar to 5-10 days in achieving symptomatic cure during uncomplicated UTI treatment, while the longer treatment is more effective in obtaining bacteriological cure.
Abstract: Background
Uncomplicated urinary tract infection (UTI) is a common disease, occurring frequently in young sexually active women. In the past, seven day antibiotic therapy was recommended while the current practice is to treat uncomplicated UTI for three days.
Objectives
TO compare the efficacy and safety of three-day antibiotic therapy to multi-day therapy (five days or longer) on relief of symptoms and bacteriuria at short-term and long-term follow-up.
Search methods
The Cochrane Library (Issue 1, 2004), the Cochrane Renal Group's Register of trials (July 2003), EMBASE (January 1980 to August 2003), and MEDLINE (January 1966 to August 2003) were searched. We scanned references of all included studies and contacted the first or corresponding author of included trials and the pharmaceutical companies.
Selection criteria
Randomised controlled trials comparing three-days oral antibiotic therapy with multi-day therapy (five days and longer) for uncomplicated cystitis in 18 to 65 years old non-pregnant women without signs of upper UTI.
Data collection and analysis
Data concerning bacteriological and symptomatic failure rates, occurrence of pyelonephritis and adverse effects were extracted independently by two reviewers. Risk ratio (RR) and their 95% confidence intervals (CI) were estimated. Outcomes were also extracted by intention-to-treat analysis whenever possible.
Main results
Thirty-two trials (9605 patients) were included. For symptomatic failure rates, no difference between three-day and 5-10 day antibiotic regimen was seen short-term (RR 1.06, 95% CI 0.88 to 1.28) and long-term follow-up (RR 1.09, 95% CI 0.94 to 1.27). Comparison of the bacteriological failure rates showed that three-day therapy was less effective than 5-10 day therapy for the short-term follow-up, however this difference was observed only in the subgroup of trials that used the same antibiotic in the two treatment arms (RR 1.37, 95% CI 1.07 to 1.74, P = 0.01). This difference was more significant at long-term follow-up (RR 1.43, 95% CI 1.19 to 1.73, P = 0.0002). Adverse effects were significantly more common in the 5-10 day treatment group (RR 0.83, 95% CI 0.74 to 0.93, P = 0.0010). Results were consistent for subgroup and sensitivity analyses.
Authors' conclusions
Three days of antibiotic therapy is similar to 5-10 days in achieving symptomatic cure during uncomplicated UTI treatment, while the longer treatment is more effective in obtaining bacteriological cure. In spite of the higher rate of adverse effects, treatment for 5-10 days could be considered for treatment of women in whom eradication of bacteriuria is important.
109 citations
TL;DR: Antibiotic therapy for 3 days is similar to prolonged therapy in achieving symptomatic cure for cystitis, while the prolonged treatment is more effective in obtaining bacteriological cure.
90 citations
TL;DR: Although the body of medical evidence is increasing, it has major flaws and gaps hampering its applicability in primary care, and there is also a need to focus on the context of the medical encounter, which has been shown to influence outcome, but is still not well researched.
Abstract: The increasing availability of medical evidence in clinical practice was expected to improve the quality of care. However, this has not been realized. A possible explanation is that quality of care is a complex concept and needs a wider scope. Starting from the Donabedian triangle of structure, process and outcome, a framework for the analysis of quality of care is presented. The need for three types of evidence is identified and discussed: medical, contextual and policy evidence. Although the body of medical evidence is increasing, it has major flaws and gaps hampering its applicability in primary care. There is also a need to focus on the context of the medical encounter, which has been shown to influence outcome, but is still not well researched. Finally, evidence on costs, cost utility and equity needs to be considered. Taking these different aspects of evidence into account, an agenda for research in primary care is set. The analytical framework may provide new insights in the quest for improving quality of health care.
40 citations
TL;DR: Doubts about independence and objectivity were stated as important barriers both by physicians who had accepted a visit from an academic detailer and by those who had not, and issues need to be dealt with when designing future interventions with academic detailers.
Abstract: Background: International research has proved that academic detailing positively influences the prescribing behaviour of physicians. In the North-East Flanders region of Belgium, a quantitative study of the feasibility and acceptability of academic detailing in general practice has demonstrated that academic detailers are appreciated by physicians.Objective: In addition to the quantitative study, a qualitative study was carried out to determine physicians' attitudes to academic detailing and their objections against it.Methods: This study took place in general practice in the North-East Flanders region of Belgium, using semi-structured interviews. Nineteen physicians who had previously had a visit from an academic detailer in the quantitative study, and 19 who had refused were invited for an interview.Results: Eighteen physicians who had been visited by an academic detailer, and nine who had refused a visit agreed to be interviewed. Although most physicians who had had a visit from an academic detailer ap...
18 citations