Most clinicians do not follow recommendations against prescribing antibiotics for asymptomatic bacteriuria

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An estimated 70% of primary care physicians said in a survey that they would continue to prescribe antibiotics to treat asymptomatic infections solely on the basis of a positive urine sample. This is despite longstanding medical guidelines advising against the practice, according to a new study published today in Open JAMA Networkled by researchers at the University of Maryland School of Medicine (UMSOM).

Since 2005, medical organizations have been advocating against the routine use of antibiotics to treat patients who have bacteria detected in a urine culture but no symptoms of urinary tract infection (UTI) such as burning or frequent urination. Overwhelming evidence indicates that the drugs are not helpful for asymptomatic patients and could lead to adverse health effects like diarrhea, vomiting, skin rashes and yeast infections. Antibiotics can, in rare cases, cause death due to an overgrowth of dangerous bacteria It’s hard in the colon. The overuse of these medications has also contributed to the increase in bacterial infections that are resistant to antibiotics, difficult to treat and sometimes fatal.

In the study, UMSOM researchers surveyed 723 primary care clinicians from Texas, Mid-Atlantic, and Pacific Northwest regarding their approach to a hypothetical patient with asymptomatic bacteriuria; it is a condition in which bacteria are detected in a patient’s urine without any symptoms of UTI. They found that 71% of clinicians, 392 of the 551 who responded to the survey, would choose to treat such a patient with antibiotics, even if such treatment goes against recommended guidelines.

Our study suggests that primary care clinicians are not following widely accepted recommendations against prescribing antibiotics for asymptomatic bacteriuria. Some primary clinicians may be unaware of these recommendations, but an inappropriate prescribing culture is also likely a contributing factor. »


Jonathan Baghdadi, MD, PhD, lead author, assistant professor of epidemiology and public health at UMSOM

Family physicians were more likely to prescribe antibiotics unnecessarily compared to other specialties. Physicians who were in residency or resided in the Pacific Northwest were less likely to prescribe antibiotics.

“We found that other factors also played a role in prescribing, such as whether a doctor had a stronger preference for overtreating a disease and fear of missing a diagnosis; that person was more likely to favor the prescription of antibiotics over a physician who felt more comfortable with uncertainty in the practice of medicine,” said study leader Daniel Morgan, MD, MS, professor of epidemiology and public health at UMSOM.

One practice-changing strategy could be an education program targeting doctors who place a high priority on treatment just to make sure they don’t miss a possible infection, the researchers said in the conclusion section of the paper. . For example, redefining “unnecessary treatment” with antibiotics as “potentially harmful” treatment with antibiotics could help curb the trend of overprescribing.

UMSOM faculty and staff Lisa Pineles, MA, Alison Lydecker, MPH, Larry Magder, PhD, and Deborah Stevens, LCSW-C, MPH, were study co-authors. Researchers from the University of Colorado School of Medicine and Memorial Sloan Kettering Cancer Center also contributed to this study.

The research was funded by the New Innovator Award from the National Institutes of Health and the University of Maryland, Baltimore Institute for Clinical & Translational Research/Clinical and Translational Science Award.

Source:

Journal reference:

Baghdadi, J.D. et al. (2022) Exploring primary care clinician attitudes and cognitive characteristics associated with prescribing antibiotics for asymptomatic bacteriuria. JAMA network open. doi.org/10.1001/jamanetworkopen.2022.14268.

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