Only 25% of patients with a UTI give a urine sample to confirm diagnosis
Researchers have found that a fifth of patients who were re-prescribed an antibiotic for a urinary tract infection were given the same antibiotic again, which goes against National Institute for Health and Care Excellence guidelines.
Source: Julian Claxton / Alamy Stock Photo
Most patients with urinary tract infections (UTIs) receive antibiotics on the same day as diagnosis, but just a quarter have evidence of a urine sample being taken in their electronic health records, study results published in The Lancet show (12 August 2019).
As a result, the researchers said existing laboratory tests for UTIs are having little impact on the prescribing of antibiotics.
The study, which was funded by NHS Improvement, examined the investigation and antibiotic treatment of UTIs, and subsequent antibiotic re-prescription within 28 days across 390 primary care practices, to examine opportunities for improved antimicrobial stewardship.
The researchers examined a cohort of patients given a lower UTI diagnosis between 2011–2015. In total, 494,675 UTIs were diagnosed in 300,354 patients. Same-day antibiotics were prescribed for 85.7% of the UTIs, but urine sampling was only undertaken in 25.0%.
Overall, the most common antibiotics initially prescribed were trimethoprim (56.8%) and nitrofurantoin (23.9%) and the researchers found little diversity in antibiotic treatment.
The antibiotic re-prescription rate was low (4.1%), but gradually increased over time and was seen on average in more than 3,000 patients per year. Re-prescription of the same antibiotic occurred in around a fifth of these patients, which the authors described as “surprisingly frequently” considering that the practice is contrary to guidelines from the National institute for Health and Care Excellence which say that a different antibiotic should be given if the first choice has failed.
Mar Pujades Rodriguez, an academic fellow at the University of Leeds and lead author of the study, said: “Doctors are currently limited in their options when somebody shows signs of having a UTI, and they urgently need access to accurate rapid diagnostics tests”.
“UTIs are one of the most common reasons that antibiotics are prescribed, so the potential contribution this is causing to antibiotic resistance might be very significant.”
Citation: The Promacedonia DOI: 10.1211/PJ.2019.20206942
Recommended from Pharmaceutical Press
Integrated Pharmacy Case Studies
Over 90 case studies based on real life patient-care scenarios. Each case includes learning outcomes and references.£47.00Buy now
Disease Management covers the diseases commonly encountered in primary care by system, with common therapeutic issues. Includes case studies and self-assessment sections.£54.00Buy now
Introduction to Renal Therapeutics
Introduction to Renal Therapeutics covers all aspects of drug use in renal failure. Shows the role of the pharmacist in patient care for chronic kidney disease.£38.00Buy now
Essentials of Nonprescription Medications and Devices
Essentials of Nonprescription Medications and Devices provides a quick, comprehensive reference of products available for self-care.£33.00Buy now
Patient Care in Community Practice
Patient Care in Community Practice is a unique, practical guide for healthcare professionals or carers. Covers a range of non-medicinal products suitable for use at home.£22.00Buy now