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. 2019 Aug 12:14:23-31.
doi: 10.1016/j.eclinm.2019.07.012. eCollection 2019 Sep.

Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-prescription in Primary Care

Mar Pujades-Rodriguez  1   2 , Robert M West  1 , Mark H Wilcox  3 , Jonathan Sandoe  2   3
Affiliations

Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-prescription in Primary Care

Mar Pujades-Rodriguez et al. EClinicalMedicine. .

Abstract

Background: Urinary tract infections (UTIs) are major drivers of antibiotic prescribing in primary care. Inappropriate antibiotic prescribing for UTIs likely drives antibiotic resistance. We aimed to describe current investigation and antibiotic treatment to examine opportunities for improved antimicrobial stewardship.

Methods: We identified a cohort of all patients with lower UTI diagnosis between 2011 and 2015 in the 390 primary care practices contributing data to ResearchOne in England. We examined investigation, antibiotic treatment and antibiotic re-prescription within 28 days according to guideline-defined patient groups. We assessed risk factors for re-prescription using mixed-effect logistic regression.

Findings: In total, 494,675 UTIs were diagnosed in 300,354 patients. Median age was 54 years, and 83.3% were women. Same-day antibiotic was prescribed for 85.7% of UTIs; 56.8% were treated with trimethoprim, and urine sampling was undertaken in 25.0%. The antibiotic re-prescription rate was low (17,430, 4.1%) and increased slightly over time in men (from 5.2% in 2011 to 6.2% in 2015). Overall, 21.1% of pre-prescription were for the same antibiotic. The percentage of adults with recurrent UTIs ranged from 1.0% in 18-64 year-old men to 2.6% in women ≥ 65 years. The risk of antibiotic re-prescription increased with age, calendar year, recent antibiotic prescribing and treatment with antibiotic other than trimethoprim or nitrofurantoin.

Interpretation: Most patients diagnosed with lower UTI in primary care receive same-day empirical antibiotics with little diversity in choice of agent. The antibiotic re-prescription rate is low. Microbiological investigation and re-prescription of the same antibiotic given for the initial episode happened in one quarter of UTIs.

Funding: UK National Health Service Improvement.

Keywords: Antibiotics; Diversity; Risk factors; Treatment failure.

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Figures

Fig. 1
Fig. 1
Distribution of patients by the annual number of lower urinary tract infection episodes in adult women and men, Jan 2011–Dec 2015.
Fig. 2
Fig. 2
Distribution of the proportion of lower urinary tract infection episodes by type of antibiotic initially prescribed and patient group amongst patients with prescribed antibiotic, Jan 2011–Dec 2015.
See this image and copyright information in PMC

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