The POETIC study: Exploratory analysis of appropriate antibiotic prescribing (stage 2)

Conference: 
Talk Code: 
EP3D.07
Presenter: 
Tin Man Mandy Lau
Co-authors: 
Timothy Pickles, Kerry Hood, Emma Thomas-Jones, Elinor Coulman, Christopher Butler, Nick Francis, Mandy Wootton
Author institutions: 
Cardiff University, University of Oxford, Public Health Wales

Problem

Urinary tract infection (UTI) is the most frequent bacterial infection affecting women and accounts for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed antibiotics or antibiotics to which the organism is resistant. Many other women may not have a microbiologically-confirmed UTI but have been prescribed antibiotics. Inappropriate antibiotic prescribing unnecessarily increases risk of side effects, drives antibiotic resistance, and wastes resources.

Approach

POETIC (Stage 2) aims to describe the current management of women with suspected UTI in four countries (Wales, England, Spain and The Netherlands), including the proportions of participants that are prescribed antibiotics, those who had microbiologically-confirmed UTI, and (in those who are prescribed antibiotics) the choice of antibiotic and the susceptibility of any isolated pathogens. Combining these data along with antimicrobial resistance data, appropriate antibiotic prescribing was defined as following: Appropriate antibiotic prescribing if(a) Having a microbiologically-confirmed UTI and sensitive to the prescribed antibiotics(b) No microbiologically-confirmed UTI and no antibiotics being prescribed. Inappropriate antibiotic prescribing if(a) Having a microbiologically-confirmed UTI and resistance to the prescribed antibiotics(b) Having a microbiologically-confirmed UTI and no antibiotics being prescribed(c) Antibiotics being prescribed and no microbiologically-confirmed UTI.

Findings

797 participants were included, of which 91% provided a urine sample, and 71% returned a diary. Overall, 36% of participants had a microbiologically-confirmed UTI with wide variation in proportion between the four countries. Antibiotics were prescribed to 89% of participants at the index consultation, with similar levels across Spain (95%), England (95%) and Wales (93%), but considerably lower levels in The Netherlands (59%). There were high levels of inappropriate antibiotic prescribing in all countries (67%), with Wales and England having the highest level (76% and 75% respectively) and The Netherlands having the lowest (33%). The majority of inappropriate prescriptions were due to antibiotics being prescribed in the absence of a microbiologically-confirmed UTI.Median days to full recovery were similar between those inappropriately prescribed (10 days) and those appropriately prescribed (9 days). A similar result was found for recovery of moderately bad symptoms, here with 4 and 3 days respectively.

Consequences

The majority of women with suspected UTI are prescribed antibiotics in primary care; however, the prevalence of microbiologically-confirmed UTI is considerably lower and thus the proportion of inappropriate antibiotic prescribing is high. We therefore see that antimicrobial resistance is an important factor in this population. Although appropriate antibiotic prescribing had no significant effect on the length of recovery, only 58% of the participants were included in this analysis. Therefore sensitivity analysis or addition of similar data from the control arm of our RCT (POETIC stage 3) could be utilised to increase the power of the analysis.

Submitted by: 
Tin Man Mandy Lau
Funding acknowledgement: 
European Community's Seventh Framework Programme [FP7/2007-2013] under grant agreement n°282512.