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‘Optimise antibiotic prescribing for UTIs,’ NICE urges GPs



GPs are being urged to ‘optimise’ their use of antibiotics for treating UTIs in new draft guidance from NICE on treating UTIs.

GPs are being advised to counsel patients on effective self-care and to consider delayed prescriptions for UTIs in an effort to reduce the risk of antibiotic resistance.

The draft guidance for treating lower urinary tract infections, which is out for consultation until early June, recommends that all patients are given advice about self-care, including taking paracetamol, ensuring adequate fluid intake and explaining that there is no evidence for the use of cranberry products in treating UTI.

NICE suggests that GPs should consider waiting for microbiological results before deciding which antibiotic to prescribe, depending on the severity of the patient’s symptoms.

The guidance also recommends taking in to account the severity of symptoms, the level of risk and whether the patients has previously used antibiotics that may have led to resistance before prescribing.

NICE have also released draft guidance for acute pyelonephritis, recurrent UTI and catheter-associated UTI, which are also out for consultation.

The pyelonephritis and catheter-associated UTI guidance recommends reviewing the choice of antibiotic when urine cultures become available and changing the prescription if necessary based on the results.

Professor Mark Baker, director for the centre of guidelines at NICE, said: ‘We recognise that the majority of UTIs will require antibiotic treatment, but we need to be smarter with our use of these medicines.

‘Our new guidance will help healthcare professionals to optimise their use of antibiotics. This will help to protect these vital medicines and ensure that no one experiences side effects from a treatment they do not need.’

Dr Susan Hopkins, deputy director for antimicorbial resistance and healthcare associated infections at Public Health England, said: ‘Our surveillance shows that more than a third of laboratory confirmed E.coli UTIs display resistance to key antibiotics.

‘We are therefore urging GP practices and hospitals to follow the new guidelines so they can prescribe antibiotics appropriately to their patients. This will preserve our antibiotics so that they not only save lives today but can continue to save lives tomorrow.’

The guidance comes as Public Health England announced its ambition in February to cut GP prescribing over the next two years after research found that ‘at least’ 20% of GP antibiotic prescriptions in England were inappropriate. 

Guideline in full

Lower urinary tract infections

Give advice about managing symptoms with self-care (see the recommendations on self-care) to all people with lower UTI.

Consider a back-up antibiotic prescription or an immediate antibiotic prescription for women with lower UTI who are not pregnant. Take account of:

  • The severity of symptoms.
  • The risk of developing complications.
  • Previous urine culture and susceptibility results.
  • Previous antibiotic use which may have led to resistant bacteria.
  • Preferences of the woman for antibiotic use.

Taking account of the severity of symptoms, consider waiting until any microbiological results are available before prescribing an antibiotic for a woman with lower UTI who is not pregnant.

If a urine sample has been sent for culture and susceptibility testing and an antibiotic prescription has been given:

  • Review the choice of antibiotic when microbiological results are available, and
  • Change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not already improving, using a narrow spectrum antibiotic wherever possible.

When a back-up antibiotic prescription is given, as well as the general advice on self-care, give advice about:

  • An antibiotic not being needed immediately.
  • Using the back-up prescription if symptoms do not start to improve within 48 hours or if they worsen rapidly or significantly at any time.

Catheter-associated UTI

Offer an antibiotic to people with catheter-associated UTI. Take account of:

  • The severity of symptoms.
  • The risk of developing complications.
  • Previous urine culture and susceptibility results.
  • Previous antibiotic use which may have led to resistant bacteria.

When urine culture and susceptibility results are available:

  • Review the choice of antibiotic, and
  • Change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not already improving, using narrow spectrum antibiotics wherever possible.

Pyelonephritis

In people aged 16 years and over with acute pyelonephritis obtain a midstream urine sample before prescribing antibiotics and send for culture and susceptibility testing.

When results of urine cultures are available:

  • Review the choice of antibiotic, and
  • Change the antibiotic according to susceptibility results if the bacteria are resistant, using narrow spectrum antibiotics wherever possible.

Source: NICE