Around the world, health care professionals have cautioned that antimicrobial resistance poses an immediate threat; meanwhile, the overuse and overprescribing of antibiotics is contributing to the problem. Now, a new initiative that aimed to improve prescribing of antibiotics for urinary tract infections has proven effective, suggesting future interventions like this one could be key.
“Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections,” write the authors, led by Dr. Akke Vellinga from the National University of Ireland in Galway.
They publish their findings in CMAJ, the journal of the Canadian Medical Association.
According to the World Health Organization (WHO), there are high levels of antibiotic resistance in bacteria that cause common infections – including urinary tract infections (UTIs) – around the world.
Because UTIs are one of the most common afflictions that call for antibiotics, the researchers say efforts to inhibit use needs multi-party involvement, one that incorporates physicians, patients, pharmaceutical companies and policy makers.
As such, Dr. Vellinga and colleagues aimed to design an antibiotic-prescribing intervention for physicians that would be easy, worth their while and sustainable.
In total, 71 physicians from 30 general practices in Ireland participated in the intervention – which aimed to change prescribing behavior for UTIs – and were randomly assigned to one of three groups:
- Group A: participated in a workshop on consultation coding for UTIs and one on prescribing guidelines; received results of monthly follow-up audits
- Group B: had the same as Group A, plus received additional evidence for delayed prescribing
- Group C: control group; only participated in the coding workshop.
In the video below, Dr. Vellinga details the design and outcomes of the study in more detail:
The researchers say their primary aim was to improve the quality of antimicrobial prescribing according to guidelines, and results showed that patients whose doctors participated in group A or B were twice as likely to receive a prescription for a first-line antibiotic, which was preferably nitrofurantoin.
Additionally, compared with the control group, overall prescribing of a first-line antibiotic increased by 24.5% in group A and 18.4% in group B. Prescribing of nitrofurantoin increased by 38% in group A and 33% in group B, but it remained stable in group C.
Use of nitrofurantoin may be less harmful than other antimicrobials; after more than 50 years of use worldwide, there is little evidence of acquired resistance to nitrofurantoin, note the researchers, who say the potential negative effect of increased use of antimicrobials may be mitigated by nitrofurantoin use.
They say the change in prescribing behavior that they observed remained 5 months after the intervention was finished and add:
“The improved quality of prescribing must be put into the context of its unintended effect, an increase in actual antimicrobial prescriptions. Research has shown that the nature of complex systems, such as general practices, where many interrelated factors influence antimicrobial prescribing, makes it difficult to predict the results of interventions.”
Dr. Vellinga and colleagues note some limitations of their study. Firstly, the observed increase in overall antimicrobial prescribing for UTIs was unexpected, and they say it was not possible to determine whether this was “clinically appropriate or an unwanted consequence.”
- Antimicrobial resistance is an increasingly serious threat to global public health
- Patients with infections by drug-resistant bacteria are at increased risk of worse clinical outcomes and death
- Such patients consume more health care resources than patients infected with the same bacteria that are not resistant.
Additionally, they admit that delayed prescribing could only be identified indirectly and suggest that future studies should include the option of recording a prescription as delayed in the patient management software.
Finally, the study’s limited geographic range and the relatively small number of practices are areas of improvement for future study.
In a linked editorial to the study, Drs. Sarah Tonkin-Crine and Kyle Knox – from Oxford University in the UK – say general practitioners can play an important role in limiting antibiotic prescriptions.
“The reduction in repeat consultations (a proxy for treatment failure and thus antibiotic resistance) among patients who received nitrofurantoin, but not in the intervention arms overall, suggests that improving adherence to prescribing guidelines leads to better patient outcomes,” they write.
They caution that future studies should consider inadvertent consequences of an intervention aimed at changing behavior.
Medical News Today recently reported on a study that suggested hospital treatments are severely threatened by antibiotic resistance.