title: Does laboratory antibiotic susceptibility reporting influence primary care prescribing in urinary tract infection and other infections?
abstract: OBJECTIVE
  Using a prospective interrupted time series design, our goal was to determine whether a change in urine antibiotic susceptibility reporting from co-amoxiclav to cefalexin to community clinicians served by Southmead General Hospital led to a change in antibiotic prescribing.
  
  
  METHODS
  We used longitudinal data on antibiotic prescribing using a clinician questionnaire to identify prescribing for urinary tract infections (UTIs) when a urine specimen was submitted to microbiology; MIQUEST computer search in general practices for prescribing for all UTIs in the community; and Prescribing Analysis and Cost (PACT) data to determine antibiotic prescribing for all infections.
  
  
  RESULTS
  Cefalexin and cephalosporin prescribing increased when cefalexin was reported and co-amoxiclav prescribing decreased when co-amoxiclav was not reported by the laboratory. This was seen for episodes of UTI in which a general practitioner (GP) sent a specimen as determined with: the questionnaire results (9-fold rise in cephalosporins, 70% fall in co-amoxiclav); episodes of UTI identified by MIQUEST searches in the practice (50% increase in cefalexin, 25% reduction in co-amoxiclav); and overall antibiotic prescribing in the practice determined with PACT data (20% increase in cefalexin, 8% reduction in co-amoxiclav). MIQUEST data indicated that prescribing reverted to pre-intervention levels once the change in antibiotic reporting had stopped.
  
  
  CONCLUSIONS
  Our data provide more evidence that changing laboratory antibiotic susceptibility reporting has a direct effect on antibiotic prescribing by GPs. Our data indicate that much of the change in prescribing was attributable to the use of cefalexin and co-amoxiclav for persistent or recurrent infections. Microbiology laboratories can influence antibiotic use by selectively reporting antibiotics they would prefer GPs to prescribe.
authors.affiliation: Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL13NN, UK. cliodna.mcnulty@hpa.org.uk
authors.forename: Cliodna A M
authors.initials: CA
authors.lastname: McNulty
authors.forename: Gemma M
authors.initials: GM
authors.lastname: Lasseter
authors.forename: André
authors.initials: A
authors.lastname: Charlett
authors.forename: Andy
authors.initials: A
authors.lastname: Lovering
authors.forename: Rebecca
authors.initials: R
authors.lastname: Howell-Jones
authors.forename: Alasdair
authors.initials: A
authors.lastname: Macgowan
authors.forename: Mike
authors.initials: M
authors.lastname: Thomas
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002506:Cephalexin / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008826:Microbial Sensitivity Tests; D011320:Primary Health Care; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D002506:Cephalexin