title: Use of antimicrobial resistance information and prescribing guidance for management of urinary tract infections: survey of general practitioners in the West Midlands.
abstract: There is a marked variation in both antibiotic prescribing practice and urine sampling rates for diagnostic microbiology across general practices in England. To help understand factors driving this variation, we undertook a survey in 2012/13 to determine sampling protocols and antibiotic formularies used by general practitioners (GPs) for managing urinary tract infections (UTIs) in the West Midlands region of England.
  
  
  
  Cross-sectional survey of all eligible general practices in the West Midlands region of England undertaken in November 2012. GPs were invited to complete an online survey questionnaire to gather information on policies used within the practice for urine sampling for microbiological examination, and the source of antibiotic formularies used to guide treatment of UTIs. The questionnaire also gathered information on how they would manage five hypothetical clinical scenarios encountered in the community.
  
  
  
  The response rate was 11.3 % (409/3635 GPs), equivalent to a practice response rate of 26 % (248/950). Only 50 % of GPs reported having a practice policy for urine sampling. Although there was good agreement from GPs regarding collecting specimens in scenarios symbolising treatment failure (98 %), UTI in an adult male (98 %) and asymptomatic UTI in pregnancy (97 %), there was variation in GPs requesting a specimen for the scenarios involving a suspected uncomplicated urinary tract infection (UTI) and an asymptomatic catheterised elderly patient; with 40 and 38 % respectively indicating they would collect a specimen for microbiological examination.
  
  
  
  Standardised evidence based clinical management policies and antibiotic formularies for GPs should be readily available. This will promote the rational use of diagnostic microbiology services, improve antimicrobial stewardship and aid the interpretation of ongoing antimicrobial resistance surveillance.
authors.affiliation: Field Epidemiology Service, Public Health England, 5 St Philips Place, Birmingham, UK. dean.ironmonger@phe.gov.uk.
authors.forename: Dean
authors.initials: D
authors.lastname: Ironmonger
authors.affiliation: Field Epidemiology Service, Public Health England, 5 St Philips Place, Birmingham, UK.
authors.forename: Obaghe
authors.initials: O
authors.lastname: Edeghere
authors.affiliation: Public Health Laboratory, Public Health England, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Savita
authors.initials: S
authors.lastname: Gossain
authors.affiliation: Public Health Laboratory, Public Health England, Heart of England NHS Foundation Trust, Birmingham, UK. Peter.Hawkey@heartofengland.nhs.uk.|Institute of Microbiology and Infection, Biosciences, University of Birmingham, Birmingham, UK. Peter.Hawkey@heartofengland.nhs.uk.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hawkey
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D004739:England; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013222:State Medicine; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000652:urine
chemical_list: D000890:Anti-Infective Agents
keywords: Antibiotic prescribing; Antimicrobial resistance; Community sampling; Urinary tract infection