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doi:10.1053/jinf.2002.1095 Notice on Guidelines for General Practitioners: for Laboratory Investigation of Infections and Antibiotic Usage Sir, General practitioners' (GPs) use of the laboratory for the investigation of infections is extremely variable. Submission of urine specimens from GPs' practices ranges from 40 to 160 per 1000 patients and 60% are sent in the elderly. This is probably due to differing attitudes to the use and value of empirical treatment, near patient tests and laboratory culture of urine specimens. Chlamydia testing ranges from 1 to 40 per 1000 patients and much is performed in patients >25 years, who have a low prevalence of infection. At recent focus groups on the management of urinary tract infection (UTI), vaginal discharge and chlamydia, GPs and practice nurses have suggested that laboratory use guidance would help them decide which patients would benefit from laboratory investigation. The PHLS.SW Group GP laboratory use project team has produced guidance on laboratory use for UTI, chlamydia and vaginal discharge. These have been posted on the PHLS website (www.phls.org.uk) which can be searched by topic. The aim of the UTI guidance is to encourage urine dipstick testing in general practice, thus reducing antibiotic use and restricting laboratory testing to certain patient groups. The vaginal discharge guidance encourages empirical treatment of candida and bacterial vaginosis, based on symptoms and signs, and lists the situations in which laboratory diagnosis is most useful. The chlamydia guidance encourages testing in women under 25 years old when the cervix is examined. The guidance may be used by individual practices or by working groups involved in primary care guidance development. It is designed so that the recommendations can be changed to suit local service delivery and sampling proto- cols; for example, the laboratory methods may influence the samples that are suitable for diagnosis. Change in laboratory use may increase laboratory workload and have financial implications. Therefore the guidance will need to be taken forward in collaboration with primary care trusts (PCTs) and secondary care providers. The guidance has been produced in consultation with GPs and specialists in the field, and is in agreement with other primary care and clinical guidance, for example, Prodigy (www.prodigy.nhs.uk), SIGN (www.sign.ac.uk) and UK STD guidance (www.mssvd.org.uk). The guidance is fully referen- ced and graded for quick reference but is not all-encompassing. We would be most appreciative if you could let us have any evidence or references that support your requests for change so that we may consider them at our annual review in March 2003. We continue to update the GP antibiotic guidance six monthly. It can be found on our website: (www.phls.org.uk). Comments should be sent to Dr Cliodna McNulty, PHLS Primary Care Co-ordinator, Public Health Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN or E-mail to [email protected] or jwhiting@ phls.org.uk. Cliodna McNulty Public Health Laboratory, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK. 146 Letters to the Editor

Notice on Guidelines for General Practitioners: for Laboratory Investigation of Infections and Antibiotic Usage

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