Long-term UTI prophylaxis is started and then rarely reviewed

Design

Retrospective audit across 18 UK general practices (observational)

Population

256 adults on antibiotic prophylaxis for recurrent UTI (73.8% female, mean age 66.9)

Primary outcome

Guideline concordance, review within 6 months, modification for resistance

Effect

73.6% guideline-concordant; 58.1% reviewed by 6 months; 22.9% of resistant cases modified

An audit across 18 UK general practices examined 256 adults (mostly older women) on antibiotic prophylaxis for recurrent urinary tract infection, against the guideline expectations of regular review and response to resistance.

Prophylaxis ran a median of 2.2 years. Three-quarters were on a guideline-concordant regimen, but only 58% were reviewed within six months, and although a quarter of patients grew resistant urinary organisms, therapy was changed in fewer than a quarter of those cases. Greater deprivation was associated with lower guideline adherence.

The lesson is procedural and transferable: long-term antibiotic prophylaxis drifts on unreviewed, which drives resistance that then goes unaddressed. In India, where background antimicrobial resistance is high, the discipline of a diarised review and acting on a resistant culture matters even more. Set a review date when you start prophylaxis, and change the drug when the culture tells you to.

• Prophylaxis for recurrent UTI often continues for years without timely review.
• Only 58% of patients were reviewed within six months of starting.
• A quarter grew resistant organisms, yet therapy was rarely modified in response.
• Diarise a review date at initiation and change the drug when cultures show resistance.

Why it matters

It names a common, quiet driver of antimicrobial resistance — prophylaxis that is started and then forgotten.

Don't overread it

This is a single-region audit describing prescribing practice, not a trial of outcomes — it shows what is done, not what harm followed.

The statistics, in plain English

An audit measures adherence to standards, not treatment effects; the figures show how often review and modification happened, which flags a quality gap rather than quantifying patient harm.

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