NICE urges GPs to 'be smarter' in use of antibiotics for UTIs

Draft NICE guidance on UTIs calls on GPs to step up efforts to avoid inappropriate or overuse of antibiotics.

Guidance set out in four papers on lower, recurrent, catheter-associated and acute UTIs warns that in some circumstances antibiotics can be avoided, and backs wider use of urine testing to help identify which antibiotic is likely to be most effective when they are needed.

NICE guidelines director Professor Mark Baker said the institute recognised that most UTIs would require treatment with an antibiotic, but warned that 'we need to be smarter with our use of these medicines'.

Guidance on lower UTIs says GPs considering treatment for women who are not pregnant should decide between a 'back-up antibiotic prescription or an immediate prescription' based on severity of symptoms, possible complications for patients in at-risk groups and a range of other factors.

Antibiotic prescribing

GPs should 'consider waiting until any microbiological results are available before prescribing an antibiotic for a woman with lower UTI who is not pregnant', the NICE guidance says. If urine test results come back after an antibiotic has been prescribed, GPs should 'review the choice of antibiotic when microbiological results are available, and change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not already improving, using a narrow spectrum antibiotic wherever possible'.

Men and pregnant women with lower UTI should be offered an immediate antibiotic, again to be reviewed once microbiological results are available, the advice says.

Guidance on recurrent, acute, and catheter-associated UTIs sets out referral and management options, and key symptoms. Consultation on the four pieces of draft guidance will remain open until 5 June.

Dr Tessa Lewis, GP and chair of the managing common infections guidance committee, said: 'Urinary infections can make people feel very uncomfortable and unwell, and in some cases may become serious.

'It is important that we treat these infections with an antibiotic that will work. This new draft guidance from NICE can assist healthcare professionals to do that.'

Dr Susan Hopkins, deputy director for antimicrobial resistance at Public Health England, said: 'Our surveillance shows that more than a third of laboratory confirmed E.coli UTIs display resistance to key antibiotics. We are therefore urging GP practices and hospitals to follow the new guidelines so they can prescribe antibiotics appropriately to their patients. This will preserve our antibiotics so that they not only save lives today but can continue to save lives tomorrow.'

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