- Design
- Retrospective multi-practice audit against three prescribing standards
- Population
- 256 adults prescribed antibiotic prophylaxis for recurrent UTI across 18 general practices
- Primary outcome
- Guideline-concordant regimen, review within 6 months, and modification after resistant isolate
- Effect
- 73.6% concordant; 58.1% reviewed; 22.9% modified after resistance; resistant isolates in 24.7%
This retrospective audit covered 18 general practices in Leicestershire, England. It identified 256 adults (73.8% female, mean age 66.9) who had been prescribed antibiotic prophylaxis for recurrent urinary tract infection between November 2021 and January 2024. Median duration was 2.2 years.
Three standards were assessed. Guideline-concordant regimens were used in 73.6%, review within 6 months of starting in 58.1%, and therapy was modified after a resistant urine isolate in only 22.9% of those with resistant isolates. Nitrofurantoin and trimethoprim predominated, with frequent deviations in dose, formulation and duration. Resistant isolates occurred in 24.7% of patients and were associated with more breakthrough infection, yet rarely changed treatment. Greater socioeconomic deprivation was associated with lower guideline adherence.
An audit describes practice rather than testing an intervention, and local guidelines differ. Even so, the gaps are ones a practice can close with a recall system.
- Set a review date, within 6 months, whenever starting antibiotic prophylaxis for recurrent UTI.
- Check recent urine culture results; resistance was linked to breakthrough infection.
- Change or stop prophylaxis when an isolate is resistant to the agent in use.
- Check dose, formulation and duration against your local guideline.
- Review whether the patient still needs prophylaxis after long courses; median duration was 2.2 years.
Why it matters
Long-term prophylaxis is easy to leave running without review, even when the culture shows the antibiotic has stopped working.
Don't overread it
A retrospective audit in one English county shows prescribing patterns, not what improves outcomes; guidelines and resistance patterns differ in India.
The statistics, in plain English
Percentages here describe how often practice matched a standard, not how well patients did. The link between deprivation and lower adherence is an association in one region and may reflect case mix or workload.
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