What is the problem?

Since 2014 national antimicrobial prescribing guidelines in England have recommended the use of nitrofurantoin over trimethoprim as the first-line treatment for urinary tract infections (UTIs) in primary care. Nitrofurantoin has been prioritised over trimethoprim due to increasing antimicrobial resistance to trimethoprim and consistently low levels of nitrofurantoin resistance. However, for some areas in England, nitrofurantoin resistance in urinary Escherichia coli (the most common cause of UTI) has recently risen to over 10%, bringing it close to levels where it can no longer be recommended for first-line use.

What is the solution?

Dr Ashley Hammond’s (Bristol Medical School) project will investigate whether the recent emergence in nitrofurantoin resistance is related to the increased prescribing of nitrofurantoin, other antibiotics, and/or socioeconomic deprivation, age and sex across all Clinical Commissioning Groups (CCGs) in England.

Understanding emerging resistance to nitrofurantoin using the most up-to-date data available for the whole of English primary care will ensure that antimicrobial stewardship guidelines can be updated to reflect current evidence.

Outcome and next steps

The study findings could also inform the development of interventions in areas where resistance to nitrofurantoin is highest.