Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial

• Published in: BMJ (Online) 2023-11, Vol.383, p.e076305-e076305
• Main Authors: Schmiemann, Guido, Greser, Alexandra, Maun, Andy, Bleidorn, Jutta, Schuster, Angela, Miljukov, Olga, Rücker, Viktoria, Klingeberg, Anja, Mentzel, Anja, Minin, Vitalii, Eckmanns, Tim, Heintze, Christoph, Heuschmann, Peter, Gágyor, Ildikó
• Format: Article
• Language: English
• Subjects: Ambulatory care; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Clinical trials; Counseling; COVID-19; Data collection; Drug Prescriptions; Electronic health records; Feedback; Female; General Practice; Humans; Intervention; Medical practices; Medical records; Patients; Prescriptions; Primary care; Primary Health Care; Pyelonephritis; Respiratory Tract Infections - drug therapy; Standard deviation; Teams; Urinary tract; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - diagnosis; Urinary Tract Infections - drug therapy; Urogenital system
• ISSN: 1756-1833; 0959-8138; 1756-1833
• DOI: 10.1136/bmj-2023-076305

AbstractObjectivesTo evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women.DesignParallel, cluster randomised, controlled trial.SettingGeneral practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022.ParticipantsGeneral practitioners from 128 randomly assigned practices.InterventionsMultimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention.Main outcome measuresPrimary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes.Results110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was −0.13 (95% confidence interval −0.21 to −0.06, P