More antibiotic prescriptions in UK coming from non-medical prescribers
A retrospective analysis of antibiotic prescriptions in England published yesterday in the Journal of Antimicrobial Chemotherapy found that nearly 8% of all antibiotics dispensed in primary care are prescribed by non-medical prescribers (NMPs), mostly nurses.
In the United Kingdom, NMPs—appropriately qualified non-medical healthcare professionals such as nurses, pharmacists, and allied health professionals—have the authority to independently prescribe medicine within their area of competence. They work in a variety of settings and provide a broad range of healthcare services, and their numbers are rising. To date, however, there have been no available data on the pattern of antibiotic prescribing by NPMs in England.
Using data from the National Health Service (NHS), researchers found that from July 2011 through December 2015, the number of NMPs rose by 38.5% (from 21,545 to 29,836). Of these prescribers, 89.8% were nurses, 9.9% were pharmacists, and 3.3% were allied health professionals. While the rate of all antibiotics dispensed per NMP decreased over the study period, the volume increased, with the percentage of all primary care antibiotics dispensed that were prescribed by NMPs rising from 5.6% to 7.6%, a 37.1% increase.
The vast majority of these dispensed NMP prescriptions for antibiotics were written by nurses, but the percent declined over time, from 28.79 per nurse prescriber at the beginning of 2011 to 26.22 per nurse prescriber by the end of 2015. Dispensed pharmacists' prescriptions for antibiotics, in contrast, increased from 0.83 per prescriber in January 2011 to 4.08 per prescriber in October 2015.
Penicillins were the most commonly prescribed antibiotics, followed by sulphanomides and trimethoprim, macrolides, tetracyclines, and nitrofurantoin. The data did not allow researchers to make any judgment on the appropriateness of these prescriptions
The authors conclude that with the number of NMPs in England set to rise in coming years, this group should be involved in antimicrobial stewardship efforts.
Jul 17 J Antimicrob Chemother abstract
Small study finds FMT reduces frequency of recurrent UTIs
Fecal microbiota transplantation (FMT) for treatment of recurrent Clostridium difficile infection (CDI) significantly decreased recurrent urinary tract infection (UTI) frequency and improved the antibiotic susceptibility profile of UTI-causing organisms in a small study today in Clinical Infectious Diseases.
In the study, Mayo Clinic investigators retrospectively identified eight patients who had undergone FMT for recurrent CDI (three or more episodes) and had three or more UTIs in the year preceding FMT. These patients were with to a control group of eight patients who had recurrent CDI managed with antibiotics and had three or more UTIs in the year prior to the third CDI episode.
Based on a previous study that found FMT for recurrent CDI eradicated vancomycin-resistant Enterococci (VRE) colonization in 73% of VRE-positive patients, the researchers hypothesized that FMT might also reduce the frequency of recurrent UTIs from antibiotic-resistant organisms by decolonizing multidrug-resistant organisms (MDROs) from the gut.
The results showed a significant decrease in the frequency of UTIs among the case-patients, from a median of four episodes in the year before to one episode in the year after FMT (P = 0.01). Positive urine samples cultured in the year before and after FMT showed a reduction in the most common organisms cultured, with Escherichia coli–positive samples dropping from 15 before FMT to 4 after, and Klebsiella pneumoniae-positive samples dropping from 9 to 1. In addition, susceptibility testing conducted after FMT showed a reduction in the number of E coli and K pneumoniae isolates that were resistant to ampicillin, ciprofloxacin, trimethoprim-sulfamethoxazole, and nitrofurantoin.
By comparison, the patients managed with antibiotics saw no difference in the frequency of UTIs in the year before and after the third CDI episode (a median of four UTI episodes), and no changes in antimicrobial resistance patterns in E coli and K pneumoniae isolates before and after antibiotic treatment.
"Although our findings are limited by a small sample size and lack of microbiome profiling, we demonstrate that FMT may decrease the frequency of MDRO UTIs possibly by gut decolonization through reestablishment of colonization resistance," the authors write. "This effect may lead to decreased antibiotic use, morbidity, and cost."
Jul 18 Clin Infect Dis abstract