Reducing Antibiotic Resistance in urinary tract infection in the practice - a randomised controlled trial

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

1B.2

Presenter:

Ildiko Gagyor

Co-authors:

Guido Schmiemann, Alexandra Greser, Andy Maun, Jutta Bleidorn, Angela Schuster, Christoph Heintze, Peter Heuschmann, Olga Miljukov, Tim Eckmanns, Anja Klingeberg, Anja Mentzel

Author institutions:

University of Bremen, Department of Health Services Research, Institute for Public Health and Nursing Research, Bremen, University Hospital Wuerzburg, Department of General Practice, Wuerzburg, University of Wuerzburg, Institute for clinical Epidemiology and Biometry, Division of General Practice, Faculty of Medicine, Medical Center - University of Freiburg, University Hospital Jena, Department of

Problem

Urinary tract infections (UTI) are a common reason to prescribe antibiotics in primary care, in In Germany, up to 40 % of the UTI-related prescriptions are second-line antibiotics. These drugs can substantially contribute to emerging resistance rates of uropathogens. In order to achieve a change in the prescription behavior, REDARES intends to implement recommendations of guidelines to manage uncomplicated UTI in primary care using practice-oriented information.

Approach

The aim of this randomized controlled study in general practices was evaluate whether a multimodal intervention consisting of the provision of guideline recommendations, information on regional resistance data and feedback on antibiotic prescription rates, reduces the prescribing rate of second-line antibiotics and the overall rate of antibiotic prescriptions for uncomplicated urinary tract infections (UTI) in women.

Findings

The prescription rate of second-line antibiotics was less at month 12 in the intervention group compared to the control group. After adjustment for pre-intervention rates, the mean difference between control and intervention group was lower in the latter. There was a significant difference in the rate of antibiotic prescriptions between the intervention and the control group.

Consequences

The trial demonstrated improvement in general practitioners’ prescription behavior by the multimodal intervention that reduced the rate of second-line antibiotics and antibiotic prescriptions in uncomplicated UTI in women. These results should be the basis for future measures for a guideline-adherent antibiotic prescription in German general practice.

Submitted by:

Ildiko Gagyor