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Reducing Second-Line Antibiotic Prescriptions for UTIs in Women

In 128 general practices in Germany, a multimodal intervention significantly reduced the proportion of second-line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women, researchers report. The intervention included guideline information, individual prescribing feedback, and provision of regional resistance data.

Practices in 5 regions were cluster-randomized to the intervention or control group from Apr. 2021 to Mar. 2022. The multimodal intervention consisted of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback (individual first-line and second-line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counseling).

Based on a primary outcome of the proportion of second-line antibiotics to all antibiotics prescribed for uncomplicated urinary tract infections after 1 year, the researchers determined: “110 practices with full datasets identified 10,323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was −0.13 (95% confidence interval −0.21 to −0.06, P<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of −0.08 (95% confidence interval −0.15 to −0.02, P<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups.”

Editorial: “Community acquired UTIs are caused predominantly by uropathogenic Escherichia coli, a pathogen with an increasing prevalence of antimicrobial resistance,” editorialists write. “Multiple studies have shown a direct association between antibiotic use and the selection and spread of antimicrobial resistance at the population level, including total antibiotic prescribing and proportion of broad spectrum antibiotics prescribed. Most antibiotics (80-90%) are prescribed outside of hospitals in high income countries. The pattern of antibiotic prescribing in primary care is therefore an important and modifiable driver of antimicrobial resistance. Quinolones have been used extensively for treating uncomplicated UTIs in some countries. This group of antibiotics is a key driver of resistance and associated with substantial adverse effects on nerves, muscles, and tendons.”

Source: BMJ