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Improving antibiotic prescribing for older people with urinary tract infection in primary care

Ahmed, Haroon 2018. Improving antibiotic prescribing for older people with urinary tract infection in primary care. PhD Thesis, Cardiff University.
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Urinary tract infection (UTI) is a common cause of morbidity, NHS use, and antibiotic prescribing in older people. However, few randomised trials or observational studies have explored the impact of different antibiotic prescribing strategies on UTI-related outcomes in older people. Routinely collected healthcare data provides an opportunity to investigate associations between different treatment approaches and outcomes efficiently and cost-effectively. The aim of this thesis was to carry out epidemiological analyses of linked general practice, hospital, and mortality data from the Clinical Practice Research Datalink, to understand the impact of different antibiotic prescribing strategies on outcomes in older people with acute and recurrent UTI. In chapter 4, we investigate the burden of clinically diagnosed UTI in older people in UK primary care and found that in a sample of adults aged ≥65, 21% present with at least one UTI over a 10-year period. We also found that choice and duration of antibiotic therapy improved over time. For example, between 2004 and 2014, nitrofurantoin prescribing increased, broad-spectrum antibiotic prescribing decreased, and there was an increase in the proportion of patients prescribed antibiotics for durations recommended by clinical guidelines. In chapters 5 and 7, we investigate associations between antibiotic choice and risk of treatment failure, hospitalisation and death. We found that broad-spectrum antibiotics offer little benefit over nitrofurantoin, and nitrofurantoin is associated with better outcomes than trimethoprim in patients with renal impairment. Chapter 6 investigates the impact of short versus long course antibiotic treatment on UTI outcomes in older men and found that shorter durations of treatment are associated with higher rates of treatment failure but lower rates of acute kidney injury. Chapter 8 reports a systematic review and meta-analysis of randomised trials and found that the evidence for prophylactic antibiotics for recurrent UTI in older people is based on three studies of postmenopausal women. In chapter 9, we provide the only currently available data on outcomes in older men with recurrent UTI prescribed long-term antibiotic prophylaxis. This thesis reports new evidence to support more prudent antibiotic prescribing for UTI in older people and highlights the need for more robust evidence to address challenges in diagnosis and treatment of UTI.

Item Type: Thesis (PhD)
Date Type: Submission
Status: Unpublished
Schools: Medicine
Date of First Compliant Deposit: 27 June 2019
Last Modified: 27 Jun 2019 09:00

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