UTI prophylaxis runs for years with little review, and resistant cultures rarely change it

The edition in brief

In 18 Leicestershire practices, 256 adults on prophylactic antibiotics for recurrent urinary tract infection had been treated for a median 2.2 years. Only 73.6% were on a guideline regimen, 58.1% were reviewed within six months, and just 22.9% of those with a resistant urine isolate had their drug changed, although resistance was linked to breakthrough infection. Prophylaxis needs a review date and a rule for acting on cultures. An inner-London cohort of 158,645 people found attending an NHS Health Check was associated with 32% lower all-cause mortality (HR 0.68, 0.63 to 0.74), though people who attend health checks differ from those who do not. Singapore's polyclinic 'teamlet' model of two family physicians, a nurse and a coordinator produced very small changes in HbA1c, blood pressure and LDL over five years, but more foot and eye screening, fewer admissions and a net saving of about SGD 2186 per patient. In a simulation study, 13 family physicians reached a correct diagnosis in their top three more often with a voice-based AI assistant (74.6% vs 62.3%), with a possible over-reliance signal when the AI was wrong.