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Study to improve antibiotic prescribing for urinary tract infections

antibiotic pills

Published: 21 July 2023

NIHR has awarded £3 million in funding to a new study. It aims to help doctors choose the best antibiotic for treating urinary tract infections (UTIs) and reducing antimicrobial resistance (AMR).

The five-year study is known as IPAP (Improving Primary Care Antibiotic Prescribing)-UTI programme. It is led by the University of Bristol’s Centre for Academic Primary Care (CAPC). The researchers will also be working with partners in the NHS and UK Health Security Agency. The team will develop a new way to encourage clinicians to prioritise different first-choice antibiotics and assess the impact on AMR.

The challenge

AMR is a serious threat to health.  If nothing is done to combat AMR, bacteria will become resistant to more antibiotics until infections become untreatable. According to some estimates, by 2050 more people will die from AMR infections than cancer.

UTIs are the most common bacterial infection treated in the NHS. They are generally treated using antibiotics prescribed by GPs and nurses in primary care. Up to 50% of bacteria which cause UTIs are resistant to at least one antibiotic, meaning that particular antibiotic are no longer an effective treatment. This results in people getting longer, more severe infections. They may also need more antibiotics.

Randomised controlled trials

Randomised controlled trials (RCTs) are considered the only reliable method to investigate the effectiveness of medicines. In RCTs, the treatment given to each patient is randomly selected. The team will conduct three trials in areas with severe AMR problems. They will also include the groups most affected by resistant UTIs. If race, age or financial situation of participants affect outcomes, this will be reported. 

Some of the GP practices taking part in the research will be encouraged to use an alternative antibiotic (or cycling of two antibiotics). The others will continue with usual care. At the end, they will compare antibiotic use and AMR rates. The results will show whether there is a better way to use antibiotics to treat UTIs and minimise the risk of AMR.

Addressing common infections

Dr Ashley Hammond, Research Fellow in Infectious Disease Epidemiology at CAPC and Programme Lead, said: "Our research programme aims to address one of the most common infections treated in primary care, where the gains for individuals, the NHS and wider public health of improved antibiotic prescribing and reduced antimicrobial resistance could be great.”

Elizabeth Beech MBE, NHS England Regional Antimicrobial Stewardship Lead supports this research focus. She said: "Urinary tract infections are very common, particularly in women who often experience UTI more than once, increasing the risk of antibiotic resistant infection. Ensuring UTI can be successfully treated quickly really matters. This research will increase our understanding of how to do this in clinical practice."


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