November 2015 Antibiotic Prescriptions of First Line Drugs Increased in Study to Promote better Prescribing for UTI

NUI Galway study includes 71 physicians, 30 general practitioners and 3,500 patients in Ireland who were randomly assigned to one of three groups with the goal of changing prescribing behaviour for urinary tract infections

An initiative to improve the prescribing of antibiotics for urinary tract infections resulted in better-quality prescribing of first line antibiotics, although the number of prescriptions also increased, according to new research carried out by NUI Galway and Oxford University. The study was published today (16 November 2015) in the Canadian Medical Association Journal (CMAJ).

The study entitled ‘Supporting the Improvement and Management of Prescribing for UTIs (SIMPle)’, first began in 2011 when NUI Galway researchers found that a variety of antibiotics were prescribed by general practitioners for urinary tract infections (UTI’s). As the spread of antibiotic resistance continues, the researchers set out to improve antibiotic prescribing for urinary tract infections in general practice and designed a cluster randomised intervention.

The study involved 71 physicians, 30 general practitioners and 3,500 patients in Ireland (Galway city and county, and Roscommon). Overall, a 20% absolute increase in prescribing of antibiotics according to guidelines was observed in the intervention groups. However, general practitioners also increased overall prescribing of antibiotics for urinary tract infection.

Dr Akke Vellinga, Epidemiologist in the College of Medicine, Nursing and Health Science at NUI Galway, and co-author of the study, said: “The increase in overall prescribing of antibiotics for urinary tract infection was unexpected, and it was not possible to conclude whether this was clinically appropriate or an unwanted consequence. The SIMPle study improved the quality of antibiotic prescribing through the use of audit reports and reminders. In a next step, the quantity of antibiotic prescribing for urinary tract infection will be addressed.”

The World Health Organisation (WHO) has deemed antibiotic resistance an immediate threat to world health. Overuse and overprescribing of antibiotics are major contributors to antibiotic-resistant diseases. Urinary tract infections are one of the most common illnesses for which antibiotics are prescribed. Efforts to curb overuse must involve patients, physicians and other health care workers, pharmaceutical companies and policy makers.

Dr Vellinga added, “The improved quality of prescribing must be put into the context of its unintended effect, an increase in actual antibiotic prescriptions. Research has shown that the nature of complex systems, such as general practices, where many interrelated factors influence antibiotic prescribing, makes it difficult to predict the results of interventions.”

Patients whose doctors participated in one of the intervention groups were twice as likely to receive a prescription for a first line antibiotic, with nitrofurantoin the preferred option. The authors suggest that if the increase in antibiotic prescribing is the result of an increase in nitrofurantoin, the potential harm may be muted as there is little evidence of acquired resistance to nitrofurantoin. They call for further study to determine if increased prescribing is clinically appropriate or an unintended result of behavioural change.

To view the SIMPle research video visit: https://www.youtube.com/watch?v=buyeYTt1uQs 

To view the CMAJ research visit: http://www.cmaj.ca/content/early/2015/11/16/cmaj.150601

For the authors Commentary visit: http://www.cmaj.ca/content/early/2015/11/16/cmaj.151103 

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