RITM0155718: Improving primary care antibiotic prescribing to reduce antibiotic resistant urine infections: the IPAP-UTI programme
This research aims to find out how effective and affordable it is to encourage doctors and nurses in primary care to use different antibiotics.
About the project
What the project aims to do
This research aims to find out how effective and affordable it is to encourage doctors and nurses in primary care to use different antibiotics. The goal is to see whether this change helps reduce resistance to the target antibiotics, by studying data from urine and blood samples that are regularly collected in healthcare settings.
The IPAP-UTI Programme is a research programme, delivered within the NHS, that has been designed to improve how urinary tract infections (UTIs) are treated in primary care and to tackle the growing problem of antimicrobial resistance (AMR). The programme is testing whether encouraging doctors to use alternative antibiotics instead of the ones with high resistance (‘target antibiotics’) can help reduce resistance and keep treatments effective for the future.
Each study within the IPAP-UTI Programme is a randomised controlled trial (RCT) – this is considered the gold standard approach for understanding if an intervention makes a real difference to ensure results are reliable and not biased.
In each RCT, GP practices will be randomly assigned to either:
- intervention group: practices receive support to switch to alternative antibiotics
- control group: practices continue with usual care
The interventions include:
- updating local prescribing guidelines to highlight recommended alternatives
- providing online training for GPs, nurses, pharmacists, and paramedics to address concerns and support the switch
- adding electronic reminders in medical records to prompt clinicians to prescribe alternative antibiotics
The University of Bristol is working with NHS areas called Integrated Care Boards (ICBs) to run the RCTs. These areas have been chosen based on where antibiotic resistance (AMR) is causing the biggest problems.
Trial details:
- RCT 1 (West Yorkshire): Focuses on replacing antibiotic A with antibiotic B for women aged over 16 with lower UTIs. For those that antibiotic B is not appropriate, antibiotic C will be considered
- RCT 2 (Kent and Medway): Focuses on replacing antibiotic A with antibiotic C for women aged over 16 with lower UTIs. For those that antibiotic C is not appropriate, antibiotic B will be considered
- RCT 3: Currently being designed and not part of this approval
We are not naming the antibiotics here to reduce the risk that the control practices learn details of the intervention, and this introduces bias.
Why this project is important
Antibiotic resistance (AMR) is a serious threat to public health. It happens when bacteria stop responding to antibiotics, the medicines that usually kill them. If this keeps happening, infections could become impossible to treat. Some experts think that by 2050, more people could die from AMR than from cancer.
One of the most common infections treated in the NHS is a urinary tract infection (UTI). These are usually treated with antibiotics. But recent studies show that up to 50% of bacteria causing UTIs are already resistant to some antibiotics. This means infections last longer, can be more severe, and sometimes people need to go to hospital for further treatment.
Recently, GPs and nurses have been told to prescribe an antibiotic called Nitrofurantoin instead of another called Trimethoprim. This might have helped reduce resistance to Trimethoprim in some places, but not everywhere. In fact, it may have caused resistance to other antibiotics to go up, which is worrying.
As a result, policy makers are now asking 2 key questions:
- are these results reliable?
- what should be done?
Who the data is about
The data covers male and female patients aged 16 years and older who had at least one of the following:
- a laboratory-confirmed urinary tract infection (UTI) or bloodstream infection (BSI)
- admission to hospital for a UTI or BSI,
- receipt of antibiotics for a UTI
Additionally, they are registered with, or treated by, a GP in an area where a randomised controlled trial (RCT) is taking place.
How the data will be used
In England, GPs are encouraged to contribute to national surveillance of antibiotic resistance (AMR). This surveillance data is controlled by the UK Health Security Agency (UKHSA) and linked to other datasets, including Hospital Episode Statistics data to understand patterns of resistance, identify problem areas, and support national policies aimed at improving antibiotic use and protecting public health.
For each RCT, UKHSA will create subsets of this this linked data, filtered to only include information from the GP practices taking part in the RCTs. UKHSA will also anonymise the data before sharing it. This means they will remove all information that could directly identify a person, such as names, addresses, NHS numbers, or dates of birth.
University of Bristol will be provided access to the anonymised data within UKHSA’s secure research environment, called the Enterprise Data and Analytics Platform (EDAP). The University of Bristol research team will use this data to measure the results of the trial and see if GPs have changed the antibiotics they prescribe in any way. Specifically, they will answer:
- does the intervention affect antibiotic resistance (AMR) to the target antibiotic?
- does the intervention reduce treatment failure in primary care for people aged over 16 with UTIs?
- does the intervention affect antibiotic resistance (AMR) to the alternative antibiotics?
- does the intervention change AMR rates for other antibiotics?
- does the intervention change the number of urine samples positive for UTI in during the trial?
- does the intervention affect antibiotic dispensing rates for all adults aged over 16?
- does the intervention change AMR rates in all bacterial isolates from adults aged over 16?
- what are the costs of the intervention?
And finally, does the intervention impact secondary care outcomes, including:
- emergency department visits for UTI or sepsis
- hospital admissions for UTI or bloodstream infection (BSI)
- deaths in patients attending ED or admitted for UTI/sepsis/BSI
The results of this analysis will be exported from EDAP and shared securely with University of Bristol for analysis within their university.
How often data is needed
Quarterly
How this project will benefit public health and the public
This research has the potential to make a real difference in how urinary tract infections are treated in primary care across the UK. It aims to provide strong, reliable evidence to help guide national policy on which antibiotics should be used, especially in areas where antibiotic resistance (AMR) is a growing problem. If successful, the findings could lead to improvements in how antibiotic prescribing guidelines are developed. While clinicians will always use their own judgement when treating patients, the research could give them better tools and clearer evidence to support their decisions, ultimately helping to protect patients.
Planned project outputs and communication
- peer reviewed scientific journals
- conference presentation
- website
- submission to regulatory authority
- press release
- other – stakeholder events.
Lawful processing of personal and special category personal data
The data needed for this project is not personal data.
Legal basis for using personal data (Article 6)
Not applicable.
Legal basis for using special category personal data (Article 9)
Not applicable.
Common law duty of confidentiality
The data needed for this project is not confidential patient information.
How is the duty of confidentiality set aside
Not applicable
National Data Opt-Out
Will opt-out preferences be applied?
No
Where “No”, why:
The National Data Opt-Out does not apply to anonymised data.
Digital Object Identifier
Not available when approved.