17 Apr 2025 Pragmatic randomised trial assessing the impact of peer comparison and therapeutic recommendations, including repetition, on antibiotic prescribing patterns of family physicians across British Columbia for uncomplicated lower urinary tract infections
, Jessica Otte, Anshula Ambasta, Wade Thompson, Colin Dormuth
First published: October 16, 2024
Online issue publication: April 17, 2025
WHAT IS ALREADY KNOWN ON THIS TOPIC
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Urinary tract infections (UTIs) are common bacterial infections in outpatients and inappropriate antibiotic prescribing has contributed to the rise of antimicrobial resistance. Audit and feedback (AF) can alter prescribing habits for this condition in small groups of family physicians (FPs).
WHAT THIS STUDY ADDS
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Sending FPs personalised prescribing AF with peer comparison and educational materials with local antibiotic resistance data was effective at improving first-line treatment of UTIs on a provincial scale. Repeated messaging appeared to sustain the impact of the intervention.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
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This study provides a roadmap for successfully implementing an AF intervention into large-scale antibiotic stewardship programmes to optimise antibiotic use and combat antimicrobial resistance.
Abstract
Objective
To evaluate the impact of a personalised audit and feedback prescribing report (AF) and brief educational summary (ES) on empiric treatment of uncomplicated lower urinary tract infections (UTIs) by family physicians (FPs).
Design
Cluster randomised control trial.
Setting
The intervention was conducted in British Columbia, Canada between 23 September 2021 and 28 March 2022.
Participants
We randomised 5073 FPs into a standard AF and ES intervention arm (n=1691), an ES-only arm (n=1691) and a control arm (n=1691).
Interventions
The AF contained personalised and peer-comparison data on first-line antibiotic prescriptions for women with uncomplicated lower UTI and key therapeutic recommendations. The ES contained detailed, evidence-based UTI management recommendations, incorporated regional antibiotic resistance data and recommended nitrofurantoin as a first-line treatment.
Main outcome measures
Nitrofurantoin as first-line pharmacological treatment for uncomplicated lower UTI, analysed using an intention-to-treat approach.
Results
We identified 21 307 cases of uncomplicated lower UTI among the three trial arms during the study period. The impact of receiving both the AF and ES increased the relative probability of prescribing nitrofurantoin as first-line treatment for uncomplicated lower UTI by 28% (OR 1.28; 95% CI 1.07 to 1.52), relative to the delay arm. This translates to additional prescribing of nitrofurantoin as first-line treatment, instead of alternates, in an additional 8.7 cases of uncomplicated UTI per 100 FPs during the 6-month study period.
Conclusion
AF prescribing data with educational materials can improve primary care prescribing of antibiotics for uncomplicated lower UTI.
Trial registration number: NCT05817253
Data availability statement
Data may be obtained from a third party and are not publicly available. Summary data are available upon reasonable request. Detailed anonymised data are available through a data access request process with the British Columbia Ministry of Health. All inferences, opinions and conclusions drawn in this manuscript are those of the authors and do not reflect the opinions or policies of the Data Stewards.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Citation
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Carney G, , , Otte J, Ambasta A, Thompson W, Dormuth C. Pragmatic randomised trial assessing the impact of peer comparison and therapeutic recommendations, including repetition, on antibiotic prescribing patterns of family physicians across British Columbia for uncomplicated lower urinary tract infections.
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