Better tests needed to reduce over-prescribing of antibiotics for UTIs – study
A fast and accurate test for diagnosing urinary tract infections (UTIs) is urgently needed to reduce over-prescribing of antibiotics, researchers say.
They argue that current bedside dipstick tests to check samples for infection are inaccurate and laboratory tests are slow.
A UTI is a relatively common problem, but in some cases it can cause complications when the infection spreads to cause kidney infection or sepsis.
New research from the University of Leeds looked at nearly 494,675 cases of UTIs in 300,354 patients in England, treated between 2011 and 2015, from records held at 390 GP practices.
It suggests that less than one in five patients treated for a UTI had a laboratory urine test to diagnose their problem.
Tests were not carried out more often in men than women, or to those who returned for a second treatment as their symptoms persisted, contrary to NHS guidelines, the researchers say.
Existing laboratory tests for UTIs are therefore having little impact on the prescribing of antibiotics.
Lead researcher Dr Mar Pujades Rodriguez, from the University of Leeds Institute of Health Sciences, said: “Doctors are currently limited in their options when somebody shows signs of having a UTI, and they urgently need access to accurate rapid diagnostics tests.
“UTIs are one of the most common reasons that antibiotics are prescribed, so the potential contribution this is causing to antibiotic resistance might be very significant.
“In addition, many patients may be making things worse by taking leftover antibiotics that they have been prescribed and using them to treat other infections, or by not finishing their course of treatment.”
The study also found that one in five patients who have to return to their doctors for a second round of treatment are being prescribed the same antibiotic that was first given.
According to researchers this is not recommended practice and could increase the chance of resistance developing.
Published in the journal EClinicalMedicine (The Lancet), the study argues that doctors require more accurate and rapid testing capabilities for UTI, and need to consider different antibiotics if a first course of treatment fails.
The study was funded by the UK’s National Health Service Improvement.
It sets out that doctors can currently use a laboratory test to diagnose a UTI, but the results take two or three days to arrive.
The test is supposed to ensure the patient actually has a UTI, and that the right antibiotic is prescribed.
However, say the researchers, only 17% of patients in the study who were treated with antibiotics had been tested.
Patients who had been prescribed antibiotics in the past three to six months were 37% more likely to require a second treatment for their UTI, compared with those who were not prescribed antibiotics.
The research also indicates that those who had been prescribed antibiotics in the past one to three months were almost twice as likely to need a second treatment.
While those prescribed antibiotics in the past month were more than three times more likely to need a second treatment, compared to those who had not been given antibiotics.
According to the researchers, these figures all suggest antibiotic resistance was the cause of treatment failure.