Improving primary care antibiotic prescribing to reduce antibiotic resistant urine infections: the IPAP-UTI programme.


National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research (PGfAR) Ref. NIHR204400.


What is the problem?

AMR is a serious threat to health. Unless we do something, bacteria will become resistant to more and more antibiotics until infections become untreatable. By 2050, some scientists predict more people will die from AMR infections than cancer.

UTIs are the most common bacterial infection treated in the NHS, mostly using antibiotics prescribed by general practitioners (GPs) and nurses in primary care. Up to 50% of bacteria which cause UTIs are resistant to at least one antibiotic, meaning that antibiotic is no longer an effective treatment. This means people can get longer, more severe infections, and need more courses of antibiotics.

GPs and nurses have been encouraged to prescribe nitrofurantoin instead of trimethoprim (both recommended first choice antibiotics for UTI). Some studies suggest this has reduced trimethoprim AMR rates but may have led to higher AMR rates for other antibiotics.

These results lead policy makers to ask two questions. First: ‘are these results reliable?’ and second: ‘what should be done?’. In answer, the data are not reliable (because methods used mean there could be other reasons for the changes), and second, nobody knows what to do next. There are lots of ideas, but we do not know if the benefits will outweigh the harms.

What is the aim of the research?

Our aim is to build reliable evidence to help doctors choose the best antibiotic for treating urinary tract infections (UTIs) in primary care, in order to reduce antibiotic (antimicrobial) resistance (AMR).

How will this be achieved?

A randomised controlled trial (RCT) is the only reliable method to investigate medicine effectiveness. This programme will include three RCTs to be conducted in areas with severe AMR problems, and will include the groups most affected. If race, age or financial situation of participants affect outcomes, this will be reported.

Some of the GP practices will be encouraged to use an alternative antibiotic (or cycling of two antibiotics) and the others will continue with usual care. At the end, we will compare antibiotic use and AMR rates, and expect that any
differences will be due to the intervention.

Who is leading the research?

Professor Alastair D Hay, Professor of Primary Care, University of Bristol.

Further information:

For more information or to get involved in this project, please contact

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.