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UTI Audit

UTI Audit. Alice Lawton GP ST3. My Audit. Patients aged >65yrs Treated for suspected/proven UTI in January 2011 Looked at choice of antibiotic, treatment length and whether MSU sent. Results. 19 patients 13F 6M Average age 78. Choice of Antibiotic. Treatment Duration. Local Guidelines.

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UTI Audit

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  1. UTI Audit Alice Lawton GP ST3

  2. My Audit • Patients aged >65yrs • Treated for suspected/proven UTI in January 2011 • Looked at choice of antibiotic, treatment length and whether MSU sent

  3. Results • 19 patients • 13F 6M • Average age 78

  4. Choice of Antibiotic

  5. Treatment Duration

  6. Local Guidelines • Trimethoprim 200mg BD OR • Nitrofurantoin 50mg QDS For 7 days

  7. Our Practice • High use of cefalexin • Against guidelines • Broad spectrum antibiotics • Increased incidence C. Difficile • MRSA • Future resistant UTIs

  8. MSU Sent?

  9. Local Guidelines • Send MSUs for all >65 • Also all men, pregnant women, children, recurrent infections and failure of treatment

  10. Quick Reminder Other UTI • Uncomplicated UTI<65yr • Trimethoprim 200mg BD or Nitrofurantoin 50mg QDS - 3 days • Men/recurrence/failure - • as per >65yrs • Pregnant women • Cefalexin 500mg BD or Amoxicillin 500mg TDS - 7 days • Children • Trimethoprim/nitrofurantoin/cefalexin - dose as per child - 7 days

  11. Catheterised Patients • Routine CSU not indicated • Do not use CSU/dipstick to diagnose • Clinical basis - sx UTI • Send CSU if sx • Change long term catheter before treatment • Choose abx from CSU if poss (trimethoprim/nitrofurantoin 7D if not) • Take into account prev CSU results • Review antibiotic • Antibiotic prophylaxis not recommended

  12. Acute Pyelonephritis • Send MSU • Co-amoxiclav 625mg TDS OR • Ciprofloxacin 500mg BD OR • Cefalexin 500mg TDS (if pregnant) 14 days

  13. Re-audit results • Correct antibiotic (ie trimethoprim/nitrofurantoin) • 76.5% (previously 42%) • Correct treatment duration of 7 days • 84.6% (prev. 78.9%) • MSU sent? • 84.6% (prev. 52.6%) • Note of the MC&S sent none were resistant to trimethoprim which was cited as a reason for prescribing cefalexin by the clinicians

  14. Conclusion • Try and avoid broad spectrum abx • Trimethoprim and nitrofurantoin are first line in all UTI treatment (apart from pregnant women) • Duration 7 days in all but uncomplicated UTIs in women <65yr • Send MSU in all but uncomplicated UTIs in women <65yr

  15. Questions?

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