A retrospective evaluation of antibiotic prescribing for recurrent urinary tract infection prophylaxis in adults in general practice.

BACKGROUND: Guidelines on the use of antibiotic prophylaxis in general practice for the prevention of recurrent urinary tract infection (UTI) are well established. However, these require regular clinical and microbiology review. Adherence to these guidelines in primary care is poorly understood. OBJECTIVES: To evaluate the prescribing of prophylactic antibiotics for recurrent UTIs in adult patients across general practices in Leicestershire (UK) and to identify potential clinical, demographic, or systemic drivers of prescribing variation. METHODS: A retrospective audit was conducted across 18 general practices in Leicestershire. Adult patients prescribed antimicrobial prophylaxis for recurrent UTI (November 2021-January 2024) were identified and evaluated against three standards: (i) guideline-concordant therapy; (ii) review within 6 months of initiation; and (iii) modification following resistant urinary isolates. Associations with demographic and clinical variables were explored. RESULTS: Among 256 patients (73.8% female; mean age 66.9 years), median prophylaxis duration was 2.2 years. Adherence to guideline regimens was 73.6%, 58.1% received review within 6 months, and 22.9% with resistant isolates had therapy modified. Nitrofurantoin and trimethoprim predominated, with frequent deviations in dose, formulation, and duration. Resistant urine isolates occurred in 24.7% and were associated with increased breakthrough infection, but rarely prompted treatment modification. Greater socioeconomic deprivation was associated with lower guideline adherence. CONCLUSIONS: This work has identified several opportunities to improve recurrent UTI management, including optimizing antimicrobial prescribing, ensuring regular clinical review, and accounting for resistant urinary isolates.