Fully 70% of primary care physicians say that they would prescribe antibiotics for patients who are asymptomatic for urinary tract infections (UTIs) when urine culture results are positive for bacteria, a new survey has found.

Such culture results — called asymptomatic bacteriuria — are common in nursing homes, with a prevalence level estimated at 50%. The survey findings suggest that many physicians are not following guidelines against overprescribing when signs and symptoms of UTI are absent, researchers said.

Investigators surveyed primary care clinicians in Texas, the Mid-Atlantic and the Pacific Northwest about how they would approach treatment of a hypothetical patient with asymptomatic bacteriuria. Fully 392 out of the 551 doctors said they would treat the patient with antibiotics based solely on the positive urine specimen results. 

Family medicine was associated with the greatest likelihood of these possibly unnecessary prescriptions, whereas physicians in residency training or residing in the Pacific Northwest were least likely to do so. In addition, clinicians who reported feeling more comfortable with uncertainty in practicing medicine were less likely to prescribe unnecessarily in these situations, reported study lead Daniel Morgan, M.D., of the University of Maryland School of Medicine.

These inadvisable prescribing practices may be due to lack of education about antibiotic stewardship, lack of awareness about the symptoms required to support a UTI diagnosis — or widespread habit, the authors noted.

“Some primary clinicians may be unaware of these recommendations, but a culture of inappropriate prescribing is also likely a contributing factor,” said Jonathan Baghdadi, M.D., Ph.D., also of the University of Maryland.

Education programs that target physicians who fear missing a possible infection may help change this dynamic, the authors said. And changing the language surrounding these prescribing practices may also be helpful, they added. They recommended using “potentially harmful” instead of “unnecessary treatment” to describe prescribing antibiotics for asymptomatic bacteriuria.

Antibiotic overprescribing may exacerbate the rise of antibiotic-resistant bacterial infections, and can sometimes cause a dangerous overgrowth of Clostridioides difficile in the colon, the study’s authors noted.

Full findings were published in JAMA Network Open.

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