Antimicrobial utilization and stewardship in patients with uncomplicated urinary tract infections managed by pharmacists in the community: A sub-study of the rxoutmap trial

Nathan P. Beahm; Daniel J. Smyth; Ross T. Tsuyuki

doi:10.3138/JAMMI-2020-0047

Antimicrobial utilization and stewardship in patients with uncomplicated urinary tract infections managed by pharmacists in the community: A sub-study of the r_xoutmap trial

Nathan P. Beahm, Daniel J. Smyth, Ross T. Tsuyuki

Medicine

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

BACKGROUND: Urinary tract infections (UTIs) often lead to suboptimal antibacterial use. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of pharmacists’ antibacterial prescribing for patients with uncomplicated UTI. METHODS: We conducted a prospective registry trial with 39 community pharmacies in New Brunswick, Canada. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (pharmacist-initial arm) or an antibacterial prescription for UTI from a physician (physician-initial arm). Pharmacists assessed patients; patients with complicating factors or red flags for systemic illness or pyelonephritis were excluded. Pharmacists prescribed antibacterial therapy or modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between study arms. RESULTS: Seven hundred fifty patients were enrolled (87% pharmacist-initial arm). The most commonly prescribed agents in the pharmacist-initial arm were nitrofurantoin (88.4%), sulfamethoxazole–trimethoprim (TMP–SMX) (7.8%), and fosfomycin (2.1%); in the physician-initial arm, nitrofurantoin (55.3%), TMP–SMX (25.5%), and fluoroquinolones (10.6%) were prescribed. Therapy was guideline concordant for 95.1% of patients in the pharmacist-initial arm and 35.1% of patients in the physician-initial arm (p < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 45.9% of patients. CONCLUSION: Treatment was highly guideline concordant when pharmacist initiated, with physicians prescribing longer treatment durations and more fluoroquinolones. This represents an important opportunity for antimicrobial stewardship interventions by pharmacists in the community.

Original language	English
Pages (from-to)	205-212
Number of pages	8
Journal	JAMMI
Volume	6
Issue number	3
DOIs	https://doi.org/10.3138/JAMMI-2020-0047
Publication status	Published - Sept 2021

Bibliographical note

Funding Information:
FUNDING: This study was funded by investigator-initiated grants from the New Brunswick Pharmacists’ Association and the Canadian Foundation for Pharmacy.

Funding Information:
This study was funded by investigator-initiated grants from the New Brunswick Pharmacists? Association and the Canadian Foundation for Pharmacy.ACKNOWLEDGEMENTS The authors acknowledge the pharmacists of the following New Brunswick pharmacies who participated in this study (in descending order of recruitment): Shoppers Drug Mart No. 191 (Saint John), Bowman?s Pharmasave (Fredericton), Shoppers Drug Mart No. 175 (Oromocto), Shoppers Drug Mart No. 193 (Quispamsis), Hampton Pharmasave, Jean Coutu Fredericton, Jean Coutu Saint Stephen, Shoppers Drug Mart No. 599 (Tracadie-Sheila), Familiprix Dieppe, Shoppers Drug Mart No. 195 (Saint John), Shoppers Drug Mart No. 176 (Fredericton), Shoppers Drug Mart No. 2005 (Dieppe), Dickison Pharmasave (Miramichi), Shoppers Drug Mart No. 177 (Grand Falls), Shoppers Drug Mart No. 593 (Moncton), Jean Coutu Dieppe Blvd (Dieppe), Shoppers Drug Mart No. 194 (Saint John), Pharmasave Steeves (Saint John), Shoppers Drug Mart No. 188 (Sussex), Shoppers Drug Mart No. 198 (Woodstock), Jean Coutu Champlain St (Dieppe), Shoppers Drug Mart No. 172 (Fredericton), Jean Coutu Tracadie-Sheila, Pharmasave Bathurst, Scotts Pharmasave (Miramichi), Shoppers Drug Mart No. 165 (Miramichi), Shoppers Drug Mart No. 187 (Miramichi), DRUGStore Pharmacy No. 389 (Sussex), Shoppers Drug Mart No. 594 (Shippagan), The Medicine Shoppe Miramichi, Loblaw Pharmacy No. 341 (Fredericton), The Medicine Shoppe Fredericton Co-op, Guardian Ross Drug Rookwood Ave (Fredericton), Blackville Pharmasave, Doaktown Pharmasave, Jean Coutu Saint-Georges St (Moncton), Pharmasave Elsipogtog, Shoppers Drug Mart No. 185 (Riverview), St. Mary?s Guardian (Fredericton). The authors also acknowledge the support of the Alberta Strategy for Patient Oriented Research Support Unit Consultation and Research Services Platform (www.absporu.ca) and the work of the biostatistical and data management staff at the Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta (www.epicore.ualberta.ca).

Funding Information:
DISCLOSURES: RTT receives personal fees from Shoppers Drug Mart, personal fees from Emergent BioSystems, grants from Merck Canada, and grants from Sanofi, outside the submitted work.

Publisher Copyright:
© 2021, University of Toronto Press. All rights reserved.

ASJC Scopus Subject Areas

Microbiology (medical)
Infectious Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.3138/JAMMI-2020-0047

Cite this

@article{84e1b74286604bc695fc8bcbc304c573,

title = "Antimicrobial utilization and stewardship in patients with uncomplicated urinary tract infections managed by pharmacists in the community: A sub-study of the rxoutmap trial",

abstract = "BACKGROUND: Urinary tract infections (UTIs) often lead to suboptimal antibacterial use. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of pharmacists{\textquoteright} antibacterial prescribing for patients with uncomplicated UTI. METHODS: We conducted a prospective registry trial with 39 community pharmacies in New Brunswick, Canada. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (pharmacist-initial arm) or an antibacterial prescription for UTI from a physician (physician-initial arm). Pharmacists assessed patients; patients with complicating factors or red flags for systemic illness or pyelonephritis were excluded. Pharmacists prescribed antibacterial therapy or modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between study arms. RESULTS: Seven hundred fifty patients were enrolled (87% pharmacist-initial arm). The most commonly prescribed agents in the pharmacist-initial arm were nitrofurantoin (88.4%), sulfamethoxazole–trimethoprim (TMP–SMX) (7.8%), and fosfomycin (2.1%); in the physician-initial arm, nitrofurantoin (55.3%), TMP–SMX (25.5%), and fluoroquinolones (10.6%) were prescribed. Therapy was guideline concordant for 95.1% of patients in the pharmacist-initial arm and 35.1% of patients in the physician-initial arm (p < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 45.9% of patients. CONCLUSION: Treatment was highly guideline concordant when pharmacist initiated, with physicians prescribing longer treatment durations and more fluoroquinolones. This represents an important opportunity for antimicrobial stewardship interventions by pharmacists in the community.",

author = "Beahm, {Nathan P.} and Smyth, {Daniel J.} and Tsuyuki, {Ross T.}",

note = "Funding Information: FUNDING: This study was funded by investigator-initiated grants from the New Brunswick Pharmacists{\textquoteright} Association and the Canadian Foundation for Pharmacy. Funding Information: This study was funded by investigator-initiated grants from the New Brunswick Pharmacists? Association and the Canadian Foundation for Pharmacy.ACKNOWLEDGEMENTS The authors acknowledge the pharmacists of the following New Brunswick pharmacies who participated in this study (in descending order of recruitment): Shoppers Drug Mart No. 191 (Saint John), Bowman?s Pharmasave (Fredericton), Shoppers Drug Mart No. 175 (Oromocto), Shoppers Drug Mart No. 193 (Quispamsis), Hampton Pharmasave, Jean Coutu Fredericton, Jean Coutu Saint Stephen, Shoppers Drug Mart No. 599 (Tracadie-Sheila), Familiprix Dieppe, Shoppers Drug Mart No. 195 (Saint John), Shoppers Drug Mart No. 176 (Fredericton), Shoppers Drug Mart No. 2005 (Dieppe), Dickison Pharmasave (Miramichi), Shoppers Drug Mart No. 177 (Grand Falls), Shoppers Drug Mart No. 593 (Moncton), Jean Coutu Dieppe Blvd (Dieppe), Shoppers Drug Mart No. 194 (Saint John), Pharmasave Steeves (Saint John), Shoppers Drug Mart No. 188 (Sussex), Shoppers Drug Mart No. 198 (Woodstock), Jean Coutu Champlain St (Dieppe), Shoppers Drug Mart No. 172 (Fredericton), Jean Coutu Tracadie-Sheila, Pharmasave Bathurst, Scotts Pharmasave (Miramichi), Shoppers Drug Mart No. 165 (Miramichi), Shoppers Drug Mart No. 187 (Miramichi), DRUGStore Pharmacy No. 389 (Sussex), Shoppers Drug Mart No. 594 (Shippagan), The Medicine Shoppe Miramichi, Loblaw Pharmacy No. 341 (Fredericton), The Medicine Shoppe Fredericton Co-op, Guardian Ross Drug Rookwood Ave (Fredericton), Blackville Pharmasave, Doaktown Pharmasave, Jean Coutu Saint-Georges St (Moncton), Pharmasave Elsipogtog, Shoppers Drug Mart No. 185 (Riverview), St. Mary?s Guardian (Fredericton). The authors also acknowledge the support of the Alberta Strategy for Patient Oriented Research Support Unit Consultation and Research Services Platform (www.absporu.ca) and the work of the biostatistical and data management staff at the Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta (www.epicore.ualberta.ca). Funding Information: DISCLOSURES: RTT receives personal fees from Shoppers Drug Mart, personal fees from Emergent BioSystems, grants from Merck Canada, and grants from Sanofi, outside the submitted work. Publisher Copyright: {\textcopyright} 2021, University of Toronto Press. All rights reserved.",

year = "2021",

month = sep,

doi = "10.3138/JAMMI-2020-0047",

language = "English",

volume = "6",

pages = "205--212",

journal = "JAMMI",

issn = "2371-0888",

publisher = "University of Toronto Press",

number = "3",

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TY - JOUR

T1 - Antimicrobial utilization and stewardship in patients with uncomplicated urinary tract infections managed by pharmacists in the community

T2 - A sub-study of the rxoutmap trial

AU - Beahm, Nathan P.

AU - Smyth, Daniel J.

AU - Tsuyuki, Ross T.

N1 - Funding Information: FUNDING: This study was funded by investigator-initiated grants from the New Brunswick Pharmacists’ Association and the Canadian Foundation for Pharmacy. Funding Information: This study was funded by investigator-initiated grants from the New Brunswick Pharmacists? Association and the Canadian Foundation for Pharmacy.ACKNOWLEDGEMENTS The authors acknowledge the pharmacists of the following New Brunswick pharmacies who participated in this study (in descending order of recruitment): Shoppers Drug Mart No. 191 (Saint John), Bowman?s Pharmasave (Fredericton), Shoppers Drug Mart No. 175 (Oromocto), Shoppers Drug Mart No. 193 (Quispamsis), Hampton Pharmasave, Jean Coutu Fredericton, Jean Coutu Saint Stephen, Shoppers Drug Mart No. 599 (Tracadie-Sheila), Familiprix Dieppe, Shoppers Drug Mart No. 195 (Saint John), Shoppers Drug Mart No. 176 (Fredericton), Shoppers Drug Mart No. 2005 (Dieppe), Dickison Pharmasave (Miramichi), Shoppers Drug Mart No. 177 (Grand Falls), Shoppers Drug Mart No. 593 (Moncton), Jean Coutu Dieppe Blvd (Dieppe), Shoppers Drug Mart No. 194 (Saint John), Pharmasave Steeves (Saint John), Shoppers Drug Mart No. 188 (Sussex), Shoppers Drug Mart No. 198 (Woodstock), Jean Coutu Champlain St (Dieppe), Shoppers Drug Mart No. 172 (Fredericton), Jean Coutu Tracadie-Sheila, Pharmasave Bathurst, Scotts Pharmasave (Miramichi), Shoppers Drug Mart No. 165 (Miramichi), Shoppers Drug Mart No. 187 (Miramichi), DRUGStore Pharmacy No. 389 (Sussex), Shoppers Drug Mart No. 594 (Shippagan), The Medicine Shoppe Miramichi, Loblaw Pharmacy No. 341 (Fredericton), The Medicine Shoppe Fredericton Co-op, Guardian Ross Drug Rookwood Ave (Fredericton), Blackville Pharmasave, Doaktown Pharmasave, Jean Coutu Saint-Georges St (Moncton), Pharmasave Elsipogtog, Shoppers Drug Mart No. 185 (Riverview), St. Mary?s Guardian (Fredericton). The authors also acknowledge the support of the Alberta Strategy for Patient Oriented Research Support Unit Consultation and Research Services Platform (www.absporu.ca) and the work of the biostatistical and data management staff at the Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta (www.epicore.ualberta.ca). Funding Information: DISCLOSURES: RTT receives personal fees from Shoppers Drug Mart, personal fees from Emergent BioSystems, grants from Merck Canada, and grants from Sanofi, outside the submitted work. Publisher Copyright: © 2021, University of Toronto Press. All rights reserved.

PY - 2021/9

Y1 - 2021/9

N2 - BACKGROUND: Urinary tract infections (UTIs) often lead to suboptimal antibacterial use. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of pharmacists’ antibacterial prescribing for patients with uncomplicated UTI. METHODS: We conducted a prospective registry trial with 39 community pharmacies in New Brunswick, Canada. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (pharmacist-initial arm) or an antibacterial prescription for UTI from a physician (physician-initial arm). Pharmacists assessed patients; patients with complicating factors or red flags for systemic illness or pyelonephritis were excluded. Pharmacists prescribed antibacterial therapy or modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between study arms. RESULTS: Seven hundred fifty patients were enrolled (87% pharmacist-initial arm). The most commonly prescribed agents in the pharmacist-initial arm were nitrofurantoin (88.4%), sulfamethoxazole–trimethoprim (TMP–SMX) (7.8%), and fosfomycin (2.1%); in the physician-initial arm, nitrofurantoin (55.3%), TMP–SMX (25.5%), and fluoroquinolones (10.6%) were prescribed. Therapy was guideline concordant for 95.1% of patients in the pharmacist-initial arm and 35.1% of patients in the physician-initial arm (p < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 45.9% of patients. CONCLUSION: Treatment was highly guideline concordant when pharmacist initiated, with physicians prescribing longer treatment durations and more fluoroquinolones. This represents an important opportunity for antimicrobial stewardship interventions by pharmacists in the community.

AB - BACKGROUND: Urinary tract infections (UTIs) often lead to suboptimal antibacterial use. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of pharmacists’ antibacterial prescribing for patients with uncomplicated UTI. METHODS: We conducted a prospective registry trial with 39 community pharmacies in New Brunswick, Canada. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (pharmacist-initial arm) or an antibacterial prescription for UTI from a physician (physician-initial arm). Pharmacists assessed patients; patients with complicating factors or red flags for systemic illness or pyelonephritis were excluded. Pharmacists prescribed antibacterial therapy or modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between study arms. RESULTS: Seven hundred fifty patients were enrolled (87% pharmacist-initial arm). The most commonly prescribed agents in the pharmacist-initial arm were nitrofurantoin (88.4%), sulfamethoxazole–trimethoprim (TMP–SMX) (7.8%), and fosfomycin (2.1%); in the physician-initial arm, nitrofurantoin (55.3%), TMP–SMX (25.5%), and fluoroquinolones (10.6%) were prescribed. Therapy was guideline concordant for 95.1% of patients in the pharmacist-initial arm and 35.1% of patients in the physician-initial arm (p < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 45.9% of patients. CONCLUSION: Treatment was highly guideline concordant when pharmacist initiated, with physicians prescribing longer treatment durations and more fluoroquinolones. This represents an important opportunity for antimicrobial stewardship interventions by pharmacists in the community.

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