Improving antibiotic prescribing for uncomplicated UTIs

Urinary tract infection (UTI) is a frequent reason for consulting in primary care and is the leading reason for an antibiotic prescription among women.1 Community acquired UTIs are caused predominantly by uropathogenic Escherichia coli, a pathogen with an increasing prevalence of antimicrobial resistance.2 Multiple studies have shown a direct association between antibiotic use and the selection and spread of antimicrobial resistance at the population level,3 including total antibiotic prescribing and proportion of broad spectrum antibiotics prescribed.4,5 Most antibiotics (80-90%) are prescribed outside of hospitals in high income countries. The pattern of antibiotic prescribing in primary care is therefore an important and modifiable driver of antimicrobial resistance. Quinolones have been used extensively for treating uncomplicated UTIs in some countries. This group of antibiotics is a key driver of resistance and associated with substantial adverse effects on nerves, muscles, and tendons.6

In a linked The BMJ paper (doi:10.1136/bmj-2023-076305), Schmiemann and colleagues report a large, …