200. Pharmacist Prescribing and Care for Patients with Uncomplicated Urinary Tract Infections in the Community: Antimicrobial Utilization and Stewardship Results of the RxOUTMAP Study

Abstract

BackgroundUrinary tract infections (UTI) are common infections that often result in antibacterial use that is suboptimal. There are some Canadian provinces where pharmacists have the authorization to prescribe medications for the treatment of uncomplicated UTI. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of antibacterial prescribing by pharmacists for patients with uncomplicated UTI.MethodsWe conducted a prospective registry trial in 39 community pharmacies in the Canadian province of New Brunswick. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (Pharmacist-Initial Arm) or if they presented with a prescription for an antibacterial to treat UTI from a physician (Physician-Initial Arm). Pharmacists assessed patients and if they had complicating factors or red flags for systemic illness of pyelonephritis, they were excluded from the study. Pharmacists either prescribed antibacterial therapy, modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between the study arms.ResultsA total of 748 patients were enrolled (87% in the Pharmacist-Initial Arm). The most commonly prescribed agents in the Pharmacist-Initial Arm were nitrofurantoin (88%), sulfamethoxazole–trimethoprim (TMP-SMX) (8%), and fosfomycin (2%) vs. nitrofurantoin (54%), TMP-SMX (26%), and fluoroquinolones (11%) in the Physician-Initial Arm. Nitrofurantoin was prescribed for 5 days in 97% of Pharmacist-Initial orders when compared with Physician-Initial orders where 65% were for greater than 5 days. TMP-SMX was prescribed for 3 days in 88% of Pharmacist-Initial compared with Physician-Initial where 63% were for greater than 3 days. Therapy was guideline concordant in 95% of Pharmacist-Initial compared with 35% of Physician-Initial (P < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 46% of patients.ConclusionTreatment was more guideline concordant when initiated by pharmacists, with longer treatment durations and more fluoroquinolones prescribed by physicians.Disclosures All authors: No reported disclosures.