Researchers suggest from these data that in the context of an increase of Escherichia coli bloodstream infections in England, early initiation of recommended first line antibiotics for UTI in the older population is advocated.
According to an editorial, this is one of two studies in the BMJ that highlight the daily challenge of ensuring that patients who are unlikely to benefit are not treated, whereas those who require antibiotics receive the right class, at the right time, at the right dose, and for the right duration. This task is made considerably more difficult by the absence of real-time microbiology in primary care. Both studies use invaluable routine NHS data.
It notes that this study is timely because rates of bloodstream infection (and mortality) are increasing, particularly in this age group, and the UK government has committed to halving bloodstream infections by 2021. It suggests that the relation might not be causal, however, and the implications are likely to be more nuanced than primary care doctors risking the health of older adults to meet targets for antimicrobial stewardship. It adds that although bloodstream infections associated with the urinary tract are an important and increasing problem, the annual incidence of Escherichia coli related bloodstream infection (the most common) is 37/100 000, and only half of affected patients present first to primary care. Based on the current findings, it advises that prompt treatment should be offered to older patients, men (who are at higher risk than women), and those living in areas of greater socioeconomic deprivation who are at the highest risk of bloodstream infections. In addition, further research is needed to establish whether treatment should be initiated with a broad or a narrow spectrum antibiotic and to identify those in whom delaying treatment (while awaiting investigation) is safe.
The second of the studies found for most common infections treated in primary care, a substantial proportion of antibiotic prescriptions have durations exceeding those recommended in guidelines. For 931,015 consultations resulting in prescriptions, about 1.3 million days were beyond recommended durations.