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Antimicrobial Stewardship: UTI Audit

Format: Clinical Audit | Duration: 3 Months | Standard: NICE / TARGET

This template provides a ready-to-implement audit structure for primary care networks (PCNs) or community pharmacies aiming to review prescribing practices for uncomplicated lower urinary tract infections (UTIs) in women.

1. Rationale & Background

Antimicrobial resistance (AMR) remains a critical global threat. In primary care, UTIs account for a vast proportion of empirical antibiotic prescriptions. NICE guidance (NG109) stipulates that Nitrofurantoin (if eGFR > 45) or Trimethoprim (if local resistance < 20%) should be first-line, typically for a 3-day course in uncomplicated cases.

Despite this, audits frequently reveal 5-day or 7-day courses being prescribed inappropriately, or broad-spectrum agents (like Cefalexin or Co-amoxiclav) used first-line without culture sensitivities.

2. Audit Criteria and Standards

Criterion Standard Exception
First-line agent prescribed is Nitrofurantoin or Trimethoprim. 100% Documented allergy or specific MSU culture sensitivities dictating alternative.
Duration of course is 3 days for uncomplicated UTIs in non-pregnant women. 100% Complicated UTI, anatomical anomaly, or male patient.
If Nitrofurantoin prescribed, renal function (eGFR) checked within last 12m and is > 45 mL/min. 100% None. Absolute contraindication. (Short course may be used down to 30 eGFR in select cases, but standard remains 45).

3. Data Collection Methodology

  • Sample Size: 50 consecutive prescriptions for UTIs, or 1 month of prescribing data (whichever is greater).
  • Data points: Age, Agent, Dose, Frequency, Duration, eGFR (if Nitrofurantoin), Indication (complicated vs uncomplicated).
  • Data Source: PMR (for community pharmacy) or EMIS/SystmOne searches (for PCN pharmacists).

4. Mapping to your CPD / Revalidation

How to write the Reflective Account

Do not just submit the audit data. The GPhC wants to see the action. For example:

  1. Observation: Found 30% of Trimethoprim scripts were for 7 days.
  2. Intervention: Delivered a 10-minute huddle with the prescriber team discussing NG109. Updated the EMIS template to default to 3 days.
  3. Re-audit: 3 months later, 7-day courses dropped to 5%.
  4. Reflection: "I learned that system defaults drive prescribing behaviour more strongly than passive guideline distribution..."