Multipart primary care intervention reduces unnecessary use of antibiotics for UTIs in women
A trial in Germany found that primary care practices where patients and physicians received information on guideline recommendations and antibiotic resistance and physicians received feedback were less likely to use antibiotics for uncomplicated urinary tract infections (UTIs).
Primary care practices where both patients and physicians received information about appropriate antibiotic prescribing had lower rates of second-line and overall antibiotic use for uncomplicated urinary tract infections (UTIs) in women, a recent study found.
Researchers in Germany performed a parallel, cluster-randomized controlled trial involving general practitioners from 128 practices, with data collected between April 1, 2021, and March 31, 2022. Practices were randomly assigned in blocks of four to the intervention group or the control group. The intervention included guideline recommendations on UTI management for physicians and patients, provision of regional resistance data and information about proportions of individual first- and second-line antibiotic prescriptions, regional and supra-regional benchmarking, and telephone counseling for clinician questions. Feedback was offered quarterly. The primary outcome measure was the proportion of second-line antibiotics (all antibiotics besides trimethoprim, pivmecillinam, nitrofurantoin, fosfomycin, or nitroxoline) prescribed for UTIs after one year. The results were published Nov. 2 by BMJ.
One hundred ten practices with 10,323 cases were included. At 12 months, the mean proportion of second-line antibiotics prescribed was 0.19 (SD, 0.20) in the intervention group versus 0.35 (SD, 0.25) in the control group (mean difference, −0.13 [95% CI, −0.21 to −0.06]; P<0.001) after adjustment for preintervention proportions. There was also a decrease in all antibiotic prescriptions for UTIs over 12 months, at 0.74 (SD, 0.22) in the intervention group versus 0.80 (SD, 0.15) in the control group (mean difference, −0.08 [95% CI, −0.15 to −0.02]; P<0.029). Rates of complications within 14 days of diagnosis, such as hospital admission, fever, pyelonephritis, flank pain, or urosepsis, did not differ between the groups. Recurrent UTI rates were lower in the intervention group than in the control group (12% vs. 17%, respectively).
The study was not blinded and delayed antibiotic prescriptions could not be identified, among other limitations, the authors noted. “The multimodal intervention comprising the provision of guideline recommendations, information about regional resistance data, and individualised feedback on antibiotic prescription proportions, increased [general practitioners'] guideline adherence and reduced antibiotic prescribing in women with uncomplicated UTI in German general practices,” they concluded. “If implemented on a larger scale, our results are likely to have a sustainable positive impact on antibiotic stewardship programmes for uncomplicated UTI in primary care.”
An accompanying editorial said that the study has important implications for UTI management in primary care and shows that it's possible to change practices' antibiotic prescribing behavior.
The editorialists called for more cooperation between microbiology services and primary care clinicians, as well as additional efforts to improve antibiotic prescribing and combat resistance on a larger scale, including yearly reports of clinically relevant resistance rates, use of rapid point-of-care tests, and availability of a core set of narrow-spectrum antibiotics. “The promotion of all possible measures to control antimicrobial resistance is a collective responsibility and an urgent public health priority globally,” the editorialists wrote.