Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections.

Abstract

Currently, there are limited data on ambulatory antimicrobial stewardship (AAMS) programmes in the primary care setting. The purpose of this study was to implement a pharmacist-led AAMS programme for uncomplicated cystitis (UC) and pyelonephritis in a hospital-based family medicine residency clinic. A retrospective cohort study was used to assess clinician prescribing habits and identify areas of inappropriate prescribing. Females between 18 and 64years old diagnosed with UC or pyelonephritis were included in the analysis. The primary objective was a composite of appropriate choice of antibiotic based on first-line recommendations, appropriate dose and appropriate duration of therapy. The intervention included development of a guideline-based antibiotic treatment summary accessible in the electronic health record (EHR), clinician education sessions for medical residents and faculty, and treatment defaults in the EHR. Eighty-one patients were included in the pre-intervention group and 81 in the post-intervention group. In the pre-intervention group, 37% of patients met the composite primary outcome vs. 71.6% in the post-intervention group (P<.001) for UC and pyelonephritis combined. This was primarily driven by improvement in appropriate duration of therapy for both diagnoses which increased from 44.4% to 84.0% (P<.001). A pharmacist-led AAMS programme significantly improved guideline-based treatment adherence for UC and pyelonephritis based on the composite of appropriate choice of antibiotic, appropriate dose and appropriate duration of therapy in a primary care family medicine setting.