Physician-Targeted Interventions in Antibiotic Prescribing for Urinary Tract Infections in General Practice: A Systematic Review

Abstract

Urinary tract infections (UTIs) are the most common reason for women to consult a general practitioner (GP). While UTIs are self-limiting in half of cases, most women are prescribed antibiotics, often in discordance with established guidelines. Researchers have employed different interventions to improve GPs’ prescribing behavior, especially for respiratory infections, but it is uncertain whether these are effective for UTI care. Therefore, we performed a systematic review, including (cluster) randomized clinical trials investigating the effect of interventions targeted at GPs to improve antibiotic prescriptions for UTI. From September to December 2021 we searched the Medline, Web of Science, and CENTRAL databases, ultimately including ten studies describing eleven trials. We determined the effect of the interventions on the decision to prescribe and on the choice of antibiotic. Results showed that most studies employed multifaceted interventions, most frequently including audit & feedback and/or educational meetings. Seven out of nine trials that recorded first-choice prescriptions saw an increased proportion of first-choice antibiotics in the intervention groups compared to control groups. The employed interventions also caused a decreased proportion of at least one broad-spectrum antibiotic in five out of six studies that measured broad-spectrum antibiotic prescriptions. However, the total number of antibiotic prescriptions for UTIs increased in four out of eight studies. Therefore, while effective at influencing GPs’ prescribing behavior, future interventions should also focus on improving the decision to prescribe at all.

Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial

“…The main strength of our study comprises data for regional resistance rates as a component of the multimodal intervention that has not been used in intervention studies to improve prescribing patterns in UTI before 16. Additionally, the resistance data provided distinguished between first time and recurrent UTIs (supplementary table 8), which allowed for a more individualised clinical approach and was highly appreciated by participants 19…”

“…3 Although feedback on prescription quality has been used in intervention studies on UTIs, information about regional resistance data has not been applied to improve GPs' adherence to guideline recommendations so far. 16 Therefore, we aimed to investigate whether a multimodal intervention could reduce the number of prescriptions of second line antibiotics that GPs prescribe for women with UTIs. The intervention consisted of guideline recommendations for GPs and patients, provision of regional resistance data, and quarterly feedback that includes information on individual antibiotic prescribing proportions of first and second line antibiotics, benchmarking, and telephone counselling.…”

“…The main strength of our study comprises data for regional resistance rates as a component of the multimodal intervention that has not been used in intervention studies to improve prescribing patterns in UTI before. 16 Additionally, the resistance data provided distinguished between first time and recurrent UTIs (supplementary table 8), which allowed for a more individualised clinical approach and was highly appreciated by participants. 19 Our rigorous data extraction allowed us to focus on uncomplicated UTIs by using additional information from the electronic medical record to exclude complicating factors such as fever, flank pain, or immunosuppression at inclusion.…”

“…Guidelines recommend and advocate for collecting information about regional resistance data in urinary tract infections but this recommendation is rarely implemented in practice 3. Although feedback on prescription quality has been used in intervention studies on UTIs, information about regional resistance data has not been applied to improve GPs’ adherence to guideline recommendations so far 16…”

Antibiotic Misuse Behaviours of Older People: Confirmation of the Factor Structure of the Antibiotic Use Questionnaire

“…It is therefore particularly important to measure levels of health literacy and its influence on antibiotic use behaviours in this population [ 6 ]. Common health conditions frequently misconceived by older adults as requiring a prescription for antibiotics include upper respiratory tract infections, urinary tract infections, seeking relief from pain symptoms, and common colds and flu [ 18 , 19 , 20 ]. These misconceptions are likely driven from fear of an increased risk to health, and worsening age-related health issues [ 21 ].…”