EVOLUTION

A urinary tract infection (UTI) is an infection that affects the bladder or waterworks. UTIs are very common, and many people are given antibiotics to help treat them. But not every UTI is caused by bacteria, so antibiotics do not always help. Taking antibiotics when they are not needed can cause side effects and can make antibiotics work less well in the future.

The EVOLUTION study is looking at a new, quick urine test known as the Sysmex-Astrego PA-100 test, that can be done in the GP surgery or pharmacy. This test can show if bacteria are likely to be causing symptoms and which antibiotic is most likely to work in approximately 45 minutes. We want to see if using this new test, alongside usual NHS care, can help reduce unnecessary antibiotic use while still helping people get better safely.

By taking part, patients can help the NHS learn how to give people the right treatment at the right time.

The EVOLUTION study aims to find out whether using the PA-100 test can help reduce the need for antibiotics for urinary tract infections (UTIs), compared with usual care, without making symptoms last significantly longer.

The study will also explore patients’ and healthcare professionals’ experiences of UTI care during the study, and assess whether the PA-100 test provides good value for money for the NHS.

The EVOLUTION study aims to recruit 984 adult women who attend a participating GP practice or community pharmacy with symptoms of an uncomplicated urinary tract infection (UTI).

Participants will be asked to provide a urine sample and complete a short questionnaire about their symptoms. They will then be randomly allocated (by chance, like flipping a coin) to one of two groups:

• Usual NHS care, where healthcare professionals treat symptoms as they normally would, or
• Usual NHS care plus the new urine test, where healthcare professionals use the PA-100 test results alongside usual care to help guide treatment

Over the 28 days following enrolment, participants will be asked to complete a short online diary to record their symptoms. They will receive a £20 voucher as a thank you for their time.

Trial status: Set-up

Trial duration: 15 May 2026 - 31 Jul 2028

Benefits:

• Participants in the group using the new test may find it helps clinicians decide whether antibiotics are needed.
• Participants may feel more involved in their care and better understand their symptoms.
• Taking part may help improve future NHS care and reduce unnecessary antibiotic use.

Risks:

• No test is perfect, so there is a small chance an infection may not be detected. However, a GP or pharmacist will always consider symptoms alongside any test results and can still prescribe antibiotics if needed.
• Most people recover well from UTIs with self-care alone.

Approximately 30 sites, including GP practices and community pharmacies, will be recruited across England and Wales. Sites will be selected to represent a range of characteristics, including list size, level of deprivation, rural or urban location, and practice type.

The current list of GP practices and community pharmacies participating in the EVOLUTION study have been plotted on the map below:

EVOLUTION is funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme.

REC: 25/WM/0233

IRAS: 338088

Registration: ISRCTN17938841