The edition · Family Medicine
The alcohol blood test and the questionnaire catch different drinkers, and the UTIs that unsettle GPs
In Swedish primary care, PEth, AUDIT and self-reported drinks each flagged patients the others missed. A synthesis of 32 qualitative studies found GPs confident with UTIs until the patient was a child, a man, older or recurrent.
The edition in brief
A Swedish primary care study linked phosphatidylethanol (PEth) blood tests with AUDIT scores in 3,679 patients and with self-reported weekly drinks in 8,934. Hazardous use was flagged in 26.5% by AUDIT, about 15–18% by PEth above 210 ng/mL, and 8.5% by self-reported drinks; each method found patients the others missed, and the relationship between PEth and self-report varied by sex, age and income, so PEth works best alongside questioning rather than instead of it. A qualitative synthesis in the British Journal of General Practice, drawing on 32 studies and 677 primary care practitioners, found clinicians confident with straightforward urinary infections but uncertain with children, men, older patients and recurrent infection, under pressure from workload and patient expectations. A pilot randomised trial of 50 women with recurrent uncomplicated UTI found fewer recurrences over 26 weeks with the probiotic Escherichia coli Nissle 1917 than placebo (16.7% v 42.3%, RR 0.39, 95% CI 0.14 to 1.14), not statistically significant. The pearl covers why urine dipsticks mislead in adults over 65.
GPs are confident with UTIs until the patient is 'patient X'
For atypical UTI presentations, slow down: culture first, safety-net clearly, and follow up.
A probiotic E. coli strain: fewer UTI recurrences in a pilot, but not significantly
Do not recommend E. coli Nissle 1917 for recurrent UTI yet; the pilot result was not significant.
Urine dipsticks mislead in adults over 65
In adults over 65, diagnose UTI on symptoms and culture, not on a dipstick.
PEth and AUDIT flagged different drinkers; neither is enough alone
Combine a structured alcohol questionnaire with PEth where available; neither alone identified all hazardous drinkers.
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