Does laboratory antibiotic susceptibility reporting influence primary care prescribing in urinary tract infection and other infections?

Using a prospective interrupted time series design, our goal was to determine whether a change in urine antibiotic susceptibility reporting from co-amoxiclav to cefalexin to community clinicians served by Southmead General Hospital led to a change in antibiotic prescribing. We used longitudinal data...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2011-06, Vol.66 (6), p.1396-1404
Main Authors: MCNULTY, Cliodna A. M, LASSETER, Gemma M, CHARLETT, Andre, LOVERING, Andy, HOWELL-JONES, Rebecca, MACGOWAN, Alasdair, THOMAS, Mike
Format: Article
Language:English
Subjects:
Amoxicillin-Potassium Clavulanate Combination - therapeutic use
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Bacterial diseases
Bacterial diseases of the urinary system
Biological and medical sciences
Cephalexin - therapeutic use
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Health Services Research
Human bacterial diseases
Humans
Infectious diseases
Intervention
Medical sciences
Microbial Sensitivity Tests
Nephrology. Urinary tract diseases
Pharmacology. Drug treatments
Prescription drugs
Primary care
Primary Health Care
Prospective Studies
Urinary system involvement in other diseases. Miscellaneous
Urinary tract diseases
Urinary Tract Infections - drug therapy
Urinary Tract Infections - microbiology
Urinary tract. Prostate gland
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Summary:Using a prospective interrupted time series design, our goal was to determine whether a change in urine antibiotic susceptibility reporting from co-amoxiclav to cefalexin to community clinicians served by Southmead General Hospital led to a change in antibiotic prescribing. We used longitudinal data on antibiotic prescribing using a clinician questionnaire to identify prescribing for urinary tract infections (UTIs) when a urine specimen was submitted to microbiology; MIQUEST computer search in general practices for prescribing for all UTIs in the community; and Prescribing Analysis and Cost (PACT) data to determine antibiotic prescribing for all infections. Cefalexin and cephalosporin prescribing increased when cefalexin was reported and co-amoxiclav prescribing decreased when co-amoxiclav was not reported by the laboratory. This was seen for episodes of UTI in which a general practitioner (GP) sent a specimen as determined with: the questionnaire results (9-fold rise in cephalosporins, 70% fall in co-amoxiclav); episodes of UTI identified by MIQUEST searches in the practice (50% increase in cefalexin, 25% reduction in co-amoxiclav); and overall antibiotic prescribing in the practice determined with PACT data (20% increase in cefalexin, 8% reduction in co-amoxiclav). MIQUEST data indicated that prescribing reverted to pre-intervention levels once the change in antibiotic reporting had stopped. Our data provide more evidence that changing laboratory antibiotic susceptibility reporting has a direct effect on antibiotic prescribing by GPs. Our data indicate that much of the change in prescribing was attributable to the use of cefalexin and co-amoxiclav for persistent or recurrent infections. Microbiology laboratories can influence antibiotic use by selectively reporting antibiotics they would prefer GPs to prescribe.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkr088