Evidence from the GP Synergy NSW & ACT Research and Evaluation Unit – each month we present findings from our work that may be of interest to registrars and their supervisors.
Symptomatic urinary tract infection (UTI) is a common general practice presentation.
Antibiotics are the standard of care for UTIs but, as with any antibiotic use, antimicrobial resistance is a concern. Appropriate antibiotic stewardship in this situation includes: courses of antibiotics for no longer than needed; avoiding antibiotics if there is no UTI (involving decisions regarding empirical treatment versus waiting for pathology confirmation), and “getting the antibiotic right” first time.
So, in an analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) project, we aimed to describe registrars’ management choices made in prescribing antibiotics for UTI.
In our analyses, 1,333 registrars diagnosed 2,850 new UTIs during 189 736 consultations (1.5% of consultations; 95% CI, 1.4-1.6). Antibiotics were prescribed at 86% (95% CI, 84.7-87.2) of these index consultations. Antibiotic choice in most cases followed Australian eTG recommendations. Urine microscopy and culture were requested at the index consultation less than recommended by guidelines in men, 69.2% (95% CI, 62.6-75.1), and children, 80.8% (95% CI, 76.4-84.6). Adults were significantly more likely to be treated with antibiotics at the index consultation than children under 16.
Our interpretation of these findings is that Australian GP registrars’ choice of antibiotic for UTIs is consistent with guideline recommendations. Interpretation of the findings regarding investigation in children and men, and antibiotic prescribing in children, is more complex. These findings may be influenced by the single-consultation ‘snapshot’ nature of ReCEnT data collection. It is plausible that they may reflect registrars’ diagnostic uncertainty in the often-difficult clinical scenarios of possible UTIs in men and children – with consequent appropriate attention to antibiotic stewardship by deferring antibiotic prescription. This requires more research, focused on registrars, UTIs, and patient demographics.
Davey A, Tapley A, Mulquiney K, van Driel M, Fielding A, Holliday E, Ball J, Spike N, FitzGerald K, Magin P. Management of Urinary Tract Infection by early-career general practitioners in Australia. Journal of Evaluation in Clinical Practice (published online 25/12/19) DOI: 10.1111/jep.13340
If you would like to discuss this analysis or the paper, contact Parker Magin.