Use of trimethoprim for treatment of urinary tract infections is to be reduced under new targets for commissioners set out by NHS chiefs.
The targets for CCGs – set out in a new two-year ‘Quality Premium’ scheme starting next April – encourage prescribing nitrofurantoin over trimethoprim for younger patients, and cutting down on overall use of trimethoprim in elderly people.
If GPs reduce their use of antibiotics overall then CCGs will reward their practices, it was announced.
It comes after public health chiefs pinned recent rises in E. coli bacteremia, mainly in older people, on inappropriate antibiotic use leading to repeat infections.
The new targets form part of a measure aimed at tackling a rise in risky bloodstream infections and cutting unnecessary antibiotic use in at-risk patients. Prescribers are encouraged not to mistake bacterial colonisation for UTI.
The trimethoprim targets will see CCGs awarded up to around £60,000 next year if practices can achieve at least a 10% reduction in the ratio of trimethoprim to nitrofurantoin prescribed, and at least a 10% cut in trimethoprim prescribed to patients over 70. Both thresholds will be reviewed the following year.
Another target will award CCGs around £14,000 a year if practices can keep total antibiotics prescriptions at or below the 2013/14 CCG average level.
CCGs will also be aiming for a 10% reduction in E. coli bloodstream infections and starting to report primary care data on these, in two further targets making up the measure.
NHS England said the new trimethoprim targets would “work to increase the appropriate use of nitrofurantoin as first-line choice for the empirical management of UTI in primary care settings, and support reduction in inappropriate prescribing of trimethoprim which is reported to have a significantly higher rate of non-susceptibility in ‘at-risk’ groups”.
Public Health England guidance on common infections currently recommends nitrofurantoin as the first-line option for uncomplicated UTI in patients with normal kidney function, while trimethoprim or pivmecillinam are alternatives if GFR is below 45ml/min.
Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee said: “Trimethoprim which is more convenient to take, is cheaper, and better tolerated, so this will represent a change in practice for many of us.”
He added: “I would like to see efforts made to reduce the unnecessary treatment of asymptomatic bacteriuria in the elderly, as many courses of antibiotics for this are unnecessary.”
The Quality Premium scheme is a set of incentives from NHS England to CCGs potentially worth £5 per patient.