Study findings published in EClincialMedicine showed that more than 85% of patients in England who are diagnosed with a lower UTI in primary care receive an antibiotic on the same day, and that most do not have a recorded urine test within 10 days of diagnosis.
“We found that less than one in five patients treated for a UTI in primary care had a laboratory urine test to diagnose their problem,” Mar Pujades-Rodriguez, PhD, MSc, a clinical epidemiologist at the University of Leeds, told Infectious Disease News. “Existing laboratory tests for UTIs are therefore having little impact on the prescribing of antibiotics.”
According to Pujades-Rodriguez, current bedside dipstick tests to screen urine samples for infection are inaccurate and laboratory tests are slow. It takes between 2 and 3 days for currently available laboratory tests to determine a UTI pathogen and its antibiotic susceptibilities, she said.
The U.K.’s National Institute for Health and Care Excellence last year issued national clinical guidelines recommending narrow spectrum antibiotics to treat lower UTIs, particularly trimethoprim or nitrofurantoin. The guidelines stress that these should be offered only when the risk for resistance is low, and doctors should consider previous antibiotic use and previous urine culture and sensitivity results before recommending them.
Pujades-Rodriguez and colleagues identified a cohort of 300,354 patients and a total of 494,675 lower UTI diagnoses between 2011 and 2015 from the 390 primary care practices that contribute data to England’s ResearchOne database.
They examined investigation, antibiotic treatment and antibiotic re-prescription within 28 days according to guideline-defined patient groups and used mixed-effect logistic regression to assess risk factors for re-prescription.
The median patient age was 54 years, and 83.3% were women, according to the study. A same-day antibiotic was prescribed for 85.7% of UTIs. The most commonly prescribed initial antibiotic was trimethoprim (56.8%), followed by nitrofurantoin (23.9%). Urine sampling was undertaken in 25% of patients. Most — 83% — did not have evidence of a urine test in their electronic health records.
Pujades-Rodriguez and colleagues reported a low antibiotic re-prescription rate of 17,430 (4.1%), increasing slightly over time from 5.2% in 2011 to 6.2% in 2015. Overall, 21.1% of re-prescriptions were for the same antibiotic, they wrote. The risk of antibiotic re-prescription increased with age, calendar year, recent antibiotic prescribing and treatment with an antibiotic other than trimethoprim or nitrofurantoin.
“Thousands of people across England have been given repeat prescriptions that have little chance of curing their infection and may increase the risk for the development of antibiotic resistance,” Pujades-Rodriguez said. “Because UTIs are one of the most common reasons that antibiotics are prescribed, the potential contribution of such practices to antibiotic resistance could be significant.” – by Joe Gramigna
National Institute for Health and Care Excellence. Urinary tract infection (lower): antimicrobial prescribing. https://www.nice.org.uk/guidance/ng109. Accessed August 14, 2019.
Disclosures: The authors report support from the U.K. National Health Service Improvement. Please see the study for all authors’ relevant financial disclosures.