Objectives To compare the efficacy, safety, and acceptability of treatment with intravenous antibiotics for cellulitis at home and in hospital.

Objective: To determine whether community management of mild to moderate community‐acquired pneumonia (CAP) is as effective and acceptable as standard hospital management of CAP. Design: Randomised controlled trial. Setting: Christchurch, New Zealand, primary and secondary care. Participants: 55 patients presenting or referred to the emergency department at Christchurch Hospital with mild to moderately severe pneumonia, assessed using a validated pneumonia severity assessment score, from July 2002 to October 2003. Interventions: Hospital treatment as usual or comprehensive care in the home delivered by primary care teams. Main outcome measures: Primary: days to discharge, days on intravenous (IV) antibiotics, patient‐rated symptom scores. Secondary: health status measured using level of functioning at 2 and 6 weeks, patient satisfaction. Results: The median number of days to discharge was higher in the home care group (4 days; range, 1–14) than in the hospital groups (2 days; range, 0–10; P = 0.004). There was no difference in the number of days on IV antibiotics or on subsequent oral antibiotics. Patient‐rated symptom scores at 2 and 6 weeks, median change in symptom severity from baseline to 6 weeks, and general functioning at 2 and 6 weeks did not differ between the groups. Patients in both groups were satisfied with their treatment, with a clear preference for community treatment (P < 0.001). Conclusions: Mild to moderately severe CAP can be managed effectively in the community by primary care teams. This model of comprehensive care at home can be implemented by primary care teams with suitable funding structures.

Objective To assess the effectiveness of antibiotic treatment of women with symptoms of urinary tract infection but negative urine dipstick testing. Design Prospective, double blind, randomised, placebo controlled trial. Setting Primary care, among a randomly selected group of general practitioners in Christchurch, New Zealand. Participants 59 women aged 16-50 years presenting with a history of dysuria and frequency in whom a dipstick test of midstream urine was negative for both nitrites and leucocytes. Participants with complicated urinary tract infection were excluded. Intervention Trimethoprim 300 mg daily for three days or placebo. Main outcome measures Self reported diary of symptoms for seven days, recording the presence or absence of individual symptoms each day, followed by a structured telephone questionnaire after seven days. The main clinical outcome was resolution of dysuria at three and seven days and median time to resolution. Secondary outcomes were resolution of other symptoms. Results The median time for resolution of dysuria was three days for trimethoprim compared with five days for placebo (P = 0.002). At day 3, five (24%) of patients in the treatment group had ongoing dysuria compared with 20 (74%) in the placebo group (P = 0.005). This difference persisted until day 7: two patients (10%) in the treatment group v 11 (41%) in the placebo group; P = 0.02). The number needed to treat was 4. The median duration of constitutional symptoms (feverishness, shivers) was reduced by four days. Conclusions Although a negative dipstick test for leucocytes and nitrites accurately predicted absence of infection when standard microbiological definitions were used (negative predictive value 92%), it did not predict response to antibiotic treatment. Three days' treatment with trimethoprim significantly reduced dysuria in women whose urine dipstick test was negative. These results support the practice of empirical antibiotic use guided by symptoms. Balancing the competing interests of symptom relief and the minimisation of antibiotic use remains a dilemma-further research is needed to determine clinical predictors of response to antibiotics.

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