GPs to trial alternative antibiotics for UTIs as part of research programme
A new research programme is looking into whether encouraging GPs to use alternative antibiotics for urinary tract infections (UTIs) can help reduce antimicrobial resistance.
The UK Health Security Agency (UKHSA) said that the IPAP-UTI programme has been designed to improve how UTIs are treated in primary care and to tackle the growing problem of antimicrobial resistance.
Each study within the programme is a randomised controlled trial (RCT) in which GP practices will be randomly assigned to a group being supported to switch to alternative antibiotics, or to a group continuing with the usual care.
For practices in the first group, the interventions will include:
- updating local prescribing guidelines to highlight recommended alternatives
- providing online training for GPs, nurses, pharmacists, and paramedics to address concerns and support the switch
- adding electronic reminders in medical records to prompt clinicians to prescribe alternative antibiotics.
The University of Bristol is working with ICBs to run the RCTs, with specific areas chosen based on where AMR is ‘causing the biggest problems’ (see box).
Tral details
Trial details:
- RCT 1 (West Yorkshire): Focuses on replacing antibiotic A with antibiotic B for women aged over 16 with lower UTIs. For those that antibiotic B is not appropriate, antibiotic C will be considered
- RCT 2 (Kent and Medway): Focuses on replacing antibiotic A with antibiotic C for women aged over 16 with lower UTIs. For those that antibiotic C is not appropriate, antibiotic B will be considered
- RCT 3: Currently being designed and not part of this approval
Source: UKHSA
The antibiotics are not being named to reduce the risk that the practices learn details of the intervention and this introduces bias.
For each RCT, UKHSA will create subsets of data, filtered to only include information from the GP practices taking part in the RCTs and will also anonymise the data before sharing it.
The University of Bristol will be provided access to the anonymised data within UKHSA’s secure research environment and will use this data to measure the results of the trial and see if GPs have changed the antibiotics they prescribe in any way.
Granting permission to use UKHSA data for this programme, the agency said: ‘The programme is testing whether encouraging doctors to use alternative antibiotics instead of the ones with high resistance (target antibiotics) can help reduce resistance and keep treatments effective for the future.
‘This research has the potential to make a real difference in how urinary tract infections are treated in primary care across the UK.
‘It aims to provide strong, reliable evidence to help guide national policy on which antibiotics should be used, especially in areas where antibiotic resistance (AMR) is a growing problem.
‘If successful, the findings could lead to improvements in how antibiotic prescribing guidelines are developed.
‘While clinicians will always use their own judgement when treating patients, the research could give them better tools and clearer evidence to support their decisions, ultimately helping to protect patients.’
England’s chief medical officer recently said that clinicians including GPs should have a lower threshold for prescribing antibiotics in older people to prevent illness that can severely diminish quality of life.
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