Methods: We conducted a prospective registry trial in 39 community pharmacies in the Canadian province of New Brunswick. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (Pharmacist-Initial Arm) or if they presented with a prescription for an antibacterial to treat UTI from a physician (Physician-Initial Arm). Pharmacists assessed patients and if they had complicating factors or red flags for systemic illness of pyelonephritis, they were excluded from the study. Pharmacists either prescribed antibacterial therapy, modified antibacterial therapy, provided education only, or referred to physician, as appropriate. Antibacterial therapy prescribed was compared between the study arms.
Results: A total of 748 patients were enrolled (87% in the Pharmacist-Initial Arm). The most commonly prescribed agents in the Pharmacist-Initial Arm were nitrofurantoin (88%), sulfamethoxazole-trimethoprim (TMP-SMX) (8%), and fosfomycin (2%) vs nitrofurantoin (54%), TMP-SMX (26%), and fluoroquinolones (11%) in the Physician-Initial Arm. Nitrofurantoin was prescribed for 5 days in 97% of Pharmacist-Initial orders as compared to Physician-Initial orders where 65% were for greater than 5 days. TMP-SMX was prescribed for 3 days in 88% of Pharmacist-Initial compared to Physician-Initial where 63% were for greater than 3 days. Therapy was guideline concordant in 95% of Pharmacist-Initial compared to 35% of Physician-Initial (p < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 46% of patients.
Conclusion: Treatment was more guideline-concordant when initiated by pharmacists, with longer treatment durations and more fluoroquinolones prescribed by physicians.
R. Tsuyuki, None
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