Most physicians do not follow recommendations against prescribing antibiotics for asymptomatic bacteriuria


An estimated 70 percent of GPs said in a survey that they would still prescribe antibiotics to treat asymptomatic infections based solely on a positive urine test. This is despite longstanding medical guidelines advising against the practice, according to a new study published today JAMA network openled by researchers at the University of Maryland School of Medicine (UMSOM).

Since 2005, medical organizations have opposed the routine use of antibiotics to treat patients who have had bacteria on a urine culture but do not have symptoms of a urinary tract infection (UTI), such as burning or frequent urination. Overwhelming evidence suggests that the drugs are of no help in asymptomatic patients and can lead to adverse health effects such as diarrhea, vomiting, skin rashes and yeast infections. Antibiotics can, in rare cases, cause death due to an overgrowth of the dangerous bacteria C. difficile in the colon. Overuse of these drugs has also contributed to the rise of antibiotic-resistant bacterial infections, which are difficult to treat and sometimes fatal.

In the study, UMSOM researchers surveyed 723 primary care physicians from Texas, the Mid-Atlantic and Pacific Northwest about their approach to a hypothetical patient with asymptomatic bacteriuria; This is a condition in which bacteria are detected in the urine of a patient with no UTI symptoms. They found that 71 percent of clinicians, 392 out of 551 who took part in the survey, would choose to treat such a patient with antibiotics even though such treatment violates recommended guidelines.

Our study suggests that primary care physicians do not follow generally accepted recommendations against prescribing antibiotics for asymptomatic bacteriuria. Some GPs may not be aware of these recommendations, but a culture of inappropriate prescribing is also likely a contributing factor.”

Jonathan Baghdadi, MD, PhD, lead author, assistant professor of epidemiology and public health at UMSOM

General practitioners tend to prescribe antibiotics unnecessarily compared to other specialties. Physicians who were in residency or who lived in the Pacific Northwest were less likely to prescribe antibiotics.

“We found that other factors also played a role in prescribing, such as whether a doctor had a stronger preference for overtreating a condition and was afraid of missing a diagnosis; this person was more willing to prescribe antibiotics than a physician who was more comfortable with the uncertainty of practicing medicine,” said study leader Daniel Morgan, MD, MS, professor of epidemiology and public health at UMSOM.

One strategy to change the practice could be a training program for doctors to make treatment a high priority just to make sure they don’t miss a possible infection, the researchers said in the final part of the article. For example, reformulating an “unnecessary treatment” with antibiotics as a “potentially harmful” treatment with antibiotics could help curb the trend towards overprescribing.

UMSOM faculty and collaborators Lisa Pineles, MA, Alison Lydecker, MPH, Larry Magder, PhD, and Deborah Stevens, LCSW-C, MPH, were co-authors of the study. Researchers from the University of Colorado School of Medicine and Memorial Sloan Kettering Cancer Center also contributed to this study.

The research was funded by the New Innovator Award from the National Institutes of Health and the University of Maryland, Baltimore Institute for Clinical & Translational Research/Clinical and Translational Science Award.


University of Maryland School of Medicine

Magazine reference:

Baghdadi, JD, et al. (2022) Exploration of Primary Care Clinician Attitudes and Cognitive Characteristics Associated with Antibiotic Prescribing for Asymptomatic Bacteriuria. JAMA network open.


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