Antibiotic use in urinary tract infection

Aims of the clinical audit

To review your prescribing of antibiotics for urinary tract infection To compare your practice with the recommendations of Therapeutic Guidelines: Antibiotic, Version 12, 2003 and with the practice of other participating doctors

Please tear off each section carefully. Registration form and clinical audit forms should be returned to NPS by 9 September 2005.

How to participate
1. Select patients
Prospectively as patients present for consultation, or retrospectively from a search of electronic/paper medical records, identify 20 patients who have a diagnosis or have a provisional diagnosis of: asymptomatic bacteriuria, acute cystitis (lower urinary tract infection), or acute pyelonephritis.

5. When you receive your results

You will receive: your original clinical audit forms feedback on your individual results the aggregate results of all participants management practices commentary on the aggregate results a Review Phase pack to complete and return (see below).

2. Obtain patient consent

Patients must be informed that data from their medical records may be used for the purposes of clinical audits, and written consent must be obtained (see attached poster and patient consent form).

6. Completing the clinical audit cycle (including second data collection)

You are required to: review your individual and the aggregate results in the Feedback report identify which of your original 20 patients require follow-up record additional patient data reect on changes in management submit the Review Phase pack.

3. Record patient data (rst data collection)

Use the Patient record form to record the patients you have included. DO NOT send to NPS keep this record to assist in identifying patients for second data collection (see No. 6). Complete a clinical audit form for each patient. See notes on pages 23. Please note: patient information must only be collected and recorded by the participating doctor both full-time and part-time GPs are required to submit 20 completed clinical audit forms.

NPS has applied for clinical audit points in the 20052007 triennium of the Royal Australian College of General Practitioners (RACGP) Quality Assurance & Continuing Professional Development (QA&CPD) Program (Category 1 activity) and the Australian College of Rural and Remote Medicine (ACRRM) Professional Development Program (practice improvement category). The Review Phase pack must be completed and returned to NPS for RACGP and/or ACRRM clinical audit points to be allocated and for the clinical audit to qualify for the Quality Prescribing Initiative (QPI) of the Practice Incentives Program (PIP). You will then be sent a certicate of completion.

4. Submit the clinical audit forms

Return the 20 clinical audit forms and Registration form to: NPS Clinical Audit: Antibiotic 2005 Locked Bag 4888 STRAWBERRY HILLS NSW 2012

To be received at NPS not later than

9 September 2005
Please note: Unfortunately, late submissions cannot be accepted.

Guide to clinical audit

Professional development and PIP

Notes for clinical audit form

Additional information to assist you to review management

Patient details
Urinary tract infection (UTI) is a common bacterial infection. It is the fteenth most commonly managed problem and the fourth most frequently managed new problem in general practice.1 It can occur in males and females of all ages, however it is more common in sexually active women. The most common causative organisms of urinary tract infection are Escherichia coli and Staphylococcus saprophyticus.2

Investigations for this presentation (Q7) Dipstick tests are useful in guiding initial
management. They cannot be relied on to denitely exclude or conrm a diagnosis of a UTI. Culture the urine if it is important to make an accurate diagnosis or to select an effective antimicrobial agent.3 Urine culture2,3: should be obtained from a clean-catch midstream urine (MSU) sample for culture and sensitivity IS NOT indicated when cystitis is suspected in otherwise healthy women IS indicated for pregnant women elderly people with clinical signs of UTI recurrent cystitis treatment failure (relapse) males of any age females under 5 years of age premenarcheal females with recurrent UTI should, where possible, be collected before antibiotic treatment is commenced4,5 is recommended after the completion of antibiotic therapy in: pregnant women, men, children and patients with acute pyelonephritis. When cystitis is conrmed by a positive urine culture, males of all ages, females under 5 years of age and premenarcheal females with recurrent UTI should be investigated further to exclude any underlying abnormality2 (e.g. vesico-ureteric reux, reux nephropathy, prostate enlargement, urinary obstruction).

Your patient code (Q1) Choose your own unique identifying code for the
patient, e.g. a sequential number or the patients initials (please do not use the patients name).

Provisional/conrmed diagnosis (Q4) Please indicate one only for each patient:
asymptomatic bacteriuria acute cystitis (lower urinary tract infection), or acute pyelonephritis. Signs and symptoms of urinary tract infection Signs and symptoms include abdominal pain, behavioural disturbance, chills, cloudy/foul smelling urine, confusion, dysuria, failure to thrive, fever, frequency, haematuria, incontinence, nocturia, secondary incontinence, suprapubic discomfort, suprapubic tenderness and vomiting.35 A temperature of > 38.5C is more characteristic of pyelonephritis.3 Urinary tract infection in elderly people may present with features such as secondary incontinence, confusion, anorexia, high temperature or shock.

History of presentation (Q5) Please indicate if the current presentation for urinary
tract infection for each patient is: only episode within a 12 month period within 2 weeks of previous infection (i.e. relapse/treatment failure)3 second presentation within a 12 month period (i.e. > 2 weeks after previous infection) 3 presentations within a 12 month period (i.e. recurrent).3

Results of urine culture (Q9) Review of the patient depends on the clinical
situation. In all patients where an MSU has been sent for culture and sensitivity, check results of the culture to ensure that antibiotic treatment is appropriate.

Management
Symptomatic and other management (Q10)
Paracetamol or ibuprofen can be used to relieve pain and high temperatures.3 Cranberry juice has not been shown to be of benet in the treatment of acute urinary tract infection.3,6 There is some evidence to suggest that cranberry juice may be effective in prevention by reducing the number of symptomatic UTIs in women. Its effectiveness in children, elderly women and elderly men remains unclear.6 Urine-alkalinising agents (Atravescent, Citralite, Citravescent, sodium bicarbonate, Uracol, Ural, Uricalm, Uricosal, Urocite-K) are popular agents used in the symptomatic management of urinary symptoms which may relieve discomfort of UTIs.7 Urinealkalinising agents change the pH of the urine making some antibiotics and antibacterials less effective (e.g. hexamine hippurate [avoid concomitant use], nitrofurantoin [avoid excessive alkalinisation of urine pH > 8.0]) and increasing the risk of crystalluria when used in combination (quinolones).7,8 Increased uid intake is often recommended as symptomatic management for urinary tract infection but its effectiveness is unproven.3

Prophylactic antibiotic therapy (Q12)

In children with a positive urine culture and after the initial infective episode, antibiotic prophylaxis (with nitrofurantoin or trimethoprim) should be started immediately after the treatment course and continued until urinary tract imaging has been done.2 Women with frequent recurrences (e.g. 3 symptomatic episodes/year)3 may be considered for intermittent self-treatment, at the onset of characteristic symptoms, or prophylaxis with either: continuous low dose antibiotic prophylaxis within 2 hours after sexual intercourse. Prophylaxis instituted after successful treatment can reduce or prevent subsequent attacks and may be continued for 36 months, or in some cases longer.2 Prophylactic antibiotic treatment2 1. nitrofurantoin (child: 12.5 mg/kg up to) 50 mg orally, at night (50 mg and 100 mg capsules only; avoid use in moderate to severe renal impairment; caution in elderly) 2. cephalexin (child: 12.5 mg/kg up to) 250 mg orally, at night 3. trimethoprim (child: 2 mg/kg up to) 150 mg orally, at night (300 mg scored tablets only) Prophylactic antibiotic treatment of urinary tract infection should be considered following successful treatment of recurrent infection or where indicated in children.

Antibiotic/antibacterial (Q11)
Clearly mark the antibiotic or antibacterial prescribed, the dose, route of administration, frequency, and length of treatment used to manage this presentation. Where there is a combination product prescribed (e.g. amoxycillin+clavulanate or trimethoprim+sulfamethoxazole) only indicate the dose of the rst named compound in the combination (i.e. amoxycillin or trimethoprim). If the antibiotic prescribed is not listed please specify and indicate the reason for your choice.

Guidelines
Consistency with Therapeutic Guidelines: Antibiotic (Q16) Use the summary chart of antibiotic treatment in urinary tract infection to compare your responses to Therapeutic
Guidelines: Antibiotic, 2003 recommendations. Indicate if current management was consistent with Therapeutic Guidelines: Antibiotic by marking the box.

Summary of recommended antibiotic treatment in urinary tract infections2

Asymptomatic bacteriuria
In school-aged children, non-pregnant women and those over 60 years of age, asymptomatic bacteriuria probably does not require treatment if the urinary tract is normal (see Therapeutic Guidelines: Antibiotic, Version 12, 2003 for further information). Length of treatment 3 days 5 days 5 days 5 days

Acute cystitis (lower urinary tract infection)

Antibiotic Non-pregnant women Any of the regimens is expected to cure the majority of acute non-complicated lower UTI in non-pregnant women. Single dose therapy is not as reliable as multiple dose therapy in preventing relapse. If relapse occurs after appropriate and adequate antibiotic treatment, consider pyelonephritis and treat for 1015 days. 1. trimethoprim 300 mg orally, daily OR 2. cephalexin 500 mg orally, 12-hourly OR 3. amoxycillin+clavulanate 500+125 mg orally, 12-hourly OR 4. nitrofurantoin 50 mg orally, 6-hourly (avoid use in moderate to severe renal impairment; caution in elderly)7 Amoxycillin without clavulanate is only recommended if susceptibility of the organism is proven. If the culture is positive for Pseudomonas aeruginosa or resistance to all the above drugs has been proven consider noroxacin 400 mg orally, 12-hourly for 3 days. Pregnant women 1. cephalexin 500 mg orally, 12-hourly (category A)* OR It is important to consider the category 2. nitrofurantoin 50 mg orally, 6-hourly (category A)* of risk posed by the use of the particular (avoid use in moderate to severe renal impairment; do not use at or near term)7 antibiotic during pregnancy. OR Urine culture should be repeated after 3. amoxycillin+clavulanate 500+125 mg orally, 12-hourly (category B1)** treatment. Amoxycillin without clavulanate (category A)* is only recommended if susceptibility of the organism is proven. Men 1. trimethoprim 300 mg orally, daily OR (if there is no underlying abnormality) 2. cephalexin 500 mg orally, 12-hourly All males with a UTI should be OR investigated to exclude underlying 3. amoxycillin+clavulanate 500+125 mg orally, 12-hourly abnormality which determines the OR duration of antibiotic therapy. 4. nitrofurantoin 50 mg orally, 6-hourly (avoid use in moderate to severe renal impairment; caution in elderly)7 # Children 1. cephalexin 12.5 mg/kg up to 500 mg orally, 12-hourly OR For children with a positive urine culture 2. trimethoprim 6 mg/kg up to 300 mg orally, daily (300 mg scored tablets only) consider pyelonephritis and/or an OR underlying abnormality in males of any 3. amoxycillin+clavulanate 12.5+3.1 mg/kg up to 500+125 mg orally, 12-hourly age, females under 5 years of age and premenarcheal females with recurrent UTI. OR 4. trimethoprim+sulfamethoxazole 4+20 mg/kg up to 160+800 mg orally, 12-hourly

10 days 10 days

10 days

14 days 14 days 14 days 14 days 5 days 5 days 5 days 5 days

Acute pyelonephritis
1. cephalexin (child: 12.5 mg/kg up to) 500 mg orally, 6-hourly 10 days OR 2. amoxycillin+clavulanate (child: 22.5+3.2 mg/kg up to) 875+125 mg orally, 12-hourly 10 days OR 10 days 3. trimethoprim (child: 6 mg/kg up to) 300 mg orally, daily If the culture is positive for Pseudomonas aeruginosa or resistance to all the above drugs has been proven consider ciprooxacin 500 mg orally, 12-hourly. Severe infection parenteral treatment amoxycillin/ampicillin (child: 25 mg/kg up to) 1 g IV, 6-hourly 1014 days should be given initially, substituting oral PLUS therapy as soon as possible for a total of gentamicin (child: < 10 years: 7.5 mg/kg; 10 years: 6 mg/kg) 46 mg/kg IV, daily 1014 days. (adjust dose for renal function) Treatment should be guided by antibiotic In patients with hypersensitivity to penicillin, gentamicin alone will usually be adequate. sensitivity results. Where gentamicin is undesirable (e.g. the elderly, presence of signicant renal failure or following a previous adverse reaction), as a single drug use: cefotaxime (child: 50 mg/kg up to) 1 g IV, 8-hourly 1014 days OR ceftriaxone (child: 50 mg/kg up to) 1 g IV, daily Please note: In patients with moderate to severe renal impairment a reduced antibiotic dose may be required (see also Australian Medicines Handbook, 2005).7
* Category A: drugs which have been taken by a large number of pregnant women and women of child bearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus have been observed. **Category B1: drugs which have been taken by only a limited number of pregnant women and women of child bearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus have been observed. Quinolones should be avoided in children unless deemed necessary on microbiological grounds. Please note there are two strengths of amoxycillin+clavulanate oral liquid available (i.e. amoxycillin 25 mg/mL + clavulanate 6.25 mg/mL in 75 mL [Augmentin, Clamohexal, Clamoxyl, Clavulin] or amoxycillin 80 mg/mL + clavulanate 11.4 mg/mL in 60 mL [Augmentin Duo, Clamohexal Duo, Clamoxyl Duo, Clavulin Duo]). # After the initial infective episode, antibiotic prophylaxis (with nitrofurantoin or trimethoprim) should be commenced immediately after the cessation of the treatment course until urinary tract imaging has been done.

Mild to moderate infection

Generic and brand names for selected antibiotics

Class Aminoglycosides Cephalosporins cephalexin ceftriaxone cefotaxime Penicillins amoxycillin Alphamox, Amohexal, Amoxil, Amoxil Duo, Bgramin, Cilamox, Ibiamox, Fisamox, Maxamox, Moxacin Augmentin, Augmentin Duo, Augmentin Duo Forte, Augmentin Duo 400, Ausclav, Ausclav Duo, Ausclav Duo Forte, Ausclav Duo 400, Clamoxyl, Clamoxyl Duo, Clamoxyl Duo Forte, Clamoxyl Duo 400, Clavulin, Clavulin Duo, Clavulin Duo 400, Clavulin Duo Forte, Curam, Muric Alphacin, Ampicyn, Aspen, Austrapen, Ibimicyn Cilex, Ialex, Ibilex, Keex, Sporahexal Rocephin Generic gentamicin Brand name

amoxycillin+clavulanate

ampicillin Quinolones ciprooxacin noroxacin Other antibacterials hexamine hippurate nitrofurantion trimethoprim trimethoprim+sulfamethoxazole

C-Flox, Ciprol, Ciproxin, Prooxin, Proquin Insensye, Norohexal, Noroxin, Nuoxib, Roxin

Hiprex Macrodantin, Ralodantin Alprim, Triprim Bactrim DS, Cosig Forte, Resprim, Resprim Forte, Septrin, Septrin Forte

Patient consent
Please: display the enclosed poster (Quality assurance and your privacy) in your practice ask patients who present to the practice to read and sign a copy of the enclosed Patient information and consent form, or send the enclosed Patient information and consent form to patients whose records you wish to use retrospectively, asking them to sign and return it to the practice DO NOT send the Patient information and consent form to NPS.

The RACGP has advised that program information may be shared with researchers and interested general practitioners for the purpose of continuing education coordination at the discretion of the QA&CPD Program. Your personal details: are provided to the RACGP QA&CPD Program and/or ACRRM Professional Development Program for point allocation (if applicable) are recorded for the purpose of the PIP and NPS evaluation can be obtained from NPS by request in writing. Individual clinical audit results will not be available after potentially identifying data are removed from NPS records at the close of the clinical audit cycle. Please note: you are responsible for advising NPS of any changes of address during the audit cycle.

Privacy
By participating you agree to aggregation of your de-identied patient data and use of your personal data. Individual results of your clinical audit are kept condential by NPS. What will happen to Your patient data: your de-identied patient data forms are returned to you your individual results are provided to you only your data are aggregated with that of other participants and the de-identied aggregate results: are provided to all participants may be used in NPS evaluation and reports are provided to the RACGP and ACRRM.

Further information
Therapeutic enquiries Kim Barry at NPS: phone (02) 8217 8700 Audit and QPI enquiries Cris Abbu at NPS: phone (02) 8217 8700

References
1. Britt H, et al. General practice activity in Australia 200304. Canberra: Australian Institute of Health and Welfare (General Practice Series No 16); 2004. Report No.: AIHW Cat. No. GEP 16. 2. Therapeutic Guidelines: Antibiotic, 12th ed. Melbourne: Therapeutic Guidelines Limited; 2003. 3. PRODIGY Guidance-Urinary tract infection (lower)-women (last revised January 2004); accessed 12 January <http://www.prodigy.nhs.uk/guidance.asp?gt=uti%20(lower)%20-%20women>. 4. PRODIGY Guidance-Urinary tract infection (lower)-men (last revised September 2004); accessed 31 March <http://www.prodigy.nhs.uk/guidance.asp?gt=uti%20(lower)%20-%20men>. 5. PRODIGY Guidance-Urinary tract infection children (last revised April 2002); accessed 14 January <http://www.prodigy.nhs.uk/guidance.asp?gt=UTI%20%20children>. 6. Jepson RG, et al. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2004;(2):CD001321. 7. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2005. 8. Stockley's Drug Interactions, 6th ed. London: Royal Pharmaceutical Society of Great Britain; 2002.

The information contained in this material is derived from a critical analysis of a wide range of authoritative evidence. Any treatment decisions based on this information should be made in the context of the clinical circumstances of each patient.

NPSA0299

National Prescribing Service Limited ACN 082 034 393 An independent, Australian organisation for Quality Use of Medicines, funded by the Australian Government Department of Health and Ageing
Level 7 / 418A Elizabeth Street Surry Hills NSW 2010 Phone: 02 8217 8700 l Fax: 02 9211 7578 l email: info@nps.org.au l web: www.nps.org.au

Clinical audit: Antibiotic use in urinary tract infection

Please see the Guide to clinical audit booklet for supporting information to assist you to complete this form. Use a black biro to mark a cross (X) in the appropriate box beside your response. If you make a mistake, use white correction fluid.
NPS ofce use only

Patient details
1. Your patient code: 2. Age range:
Only indicate weight for patients aged 014 years

Management
10. Symptomatic and other management recommended for this presentation (mark all that apply) 614 years kg 1565 years > 65 years cranberry juice or cranberry tablets ibuprofen increased fluid intake intra-vaginal oestrogen paracetamol urine-alkalinising agents (e.g. Citralite, Citravescent, Sodibic, Ural) none other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ not known 11. Antibiotics/antibacterials prescribed for this presentation Please turn over to complete Q11 12. Will/have you prescribed prophylactic antibiotic/antibacterial treatment subsequent to this presentation? (See Guide page 3) yes no not known

05 years

3. Sex:

male female

premenarcheal

pregnant

postmenopausal

4. Provisional/confirmed diagnosis (mark one only) asymptomatic bacteriuria acute cystitis/lower UTI acute pyelonephritis 5. History of presentation (See Guide page 2) only episode within a 12 month period within 2 weeks of previous infection (relapse) 2nd presentation within a 12 month period 3 presentations within a 12 month period 6. History of anatomical or functional abnormality yes no not known 7. Investigations for this presentation (mark all that apply) urine dipstick (nitrate, leucocyte esterase and blood) catheter specimen of urine midstream urine (MSU) suprapubic aspiration of urine Obtained (mark all that apply) before starting antibiotic treatment after antibiotic course completed

Patient counselling
13. Was the patient educated about potential adverse effects and drug interactions with antibiotic/antibacterial treatment? yes no 14. Were instructions given to the patient on dose, frequency and duration of treatment? yes no 15. Was the patient provided with or recommended to obtain a Consumer Medicine Information leaflet? yes no

other (please specify) _______________________________________ none 8. Were investigation(s) ordered (other than urine culture)? yes (please specify) ________________________________________ no not known

Guidelines
16. Use the summary chart of recommended antibiotic treatment in urinary tract infection (see Guide page 4) to compare your responses to Therapeutic Guidelines: Antibiotic, Version 12, 2003 (Please indicate which statement applies for this patient). Prescribing of antibiotic treatment for this patient IS consistent with Therapeutic Guidelines: Antibiotic, Version 12, 2003 recommendations Prescribing of antibiotic treatment for this patient IS NOT consistent with Therapeutic Guidelines: Antibiotic, Version 12, 2003 recommendations

9. Were results of urine culture available to guide antibiotic selection? yes no not known

Please turn over to complete form

11. Antibiotics/antibacterials prescribed at this presentation None OR

Clearly mark name, dose (mg), route, frequency and duration for the antibiotic prescribed at this visit. If the patient is a child, indicate the dose in mg for each kg of weight.

Antibiotic/antibacterial prescribed and dose (brand names) Route amoxycillin

(Alphamox, Amohexal, Amoxil, Bgramin, Cilamox, Ibiamox, Fisamox, Maxamox, Moxacin)

Frequency single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________ single dose 8-hourly once daily 12-hourly 6-hourly other _____________________

Duration not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________ not applicable 7 days 3 days 10 days 5 days 14 days other _____________________

oral IV/IM

DOSE amoxycillin+clavulanate

mg or mg/kg oral

(Augmentin, Ausclav, Clamoxy, Clavulin, Curam, Muric) [Indicate dose of amoxycillin only]

DOSE ampicillin

mg or mg/kg oral IV/IM mg or mg/kg IV/IM mg or mg/kg

(Alphacin, Ampicyn, Aspen, Austrapen, Ibimicyn)

DOSE cefotaxime DOSE ceftriaxone

(Rocephin)

IV/IM mg or mg/kg oral mg or mg/kg oral IV/IM mg or mg/kg IV/IM mg or mg/kg

DOSE cephalexin

(Cilex, Ialex, Ibilex, Keflex, Sporahexal)

DOSE ciprofloxacin

(C-Flox, Ciprol, Ciproxin, Profloxin, Proquin)

DOSE gentamicin DOSE hexamine hippurate

(Hiprex)

oral mg or mg/kg oral mg or mg/kg oral mg or mg/kg oral mg or mg/kg oral IV/IM

DOSE nitrofurantoin
(Macrodantin, Ralodantin)

DOSE norfloxacin

(Insensye, Norflohexal, Noroxin, Nufloxib, Roxin)

DOSE trimethoprim
(Alprim, Triprim)

DOSE

trimethoprim+sulfamethoxazole
(Bactrim, Cosig Forte, Resprim, Septrin) [Indicate dose of trimethoprim only]

DOSE

mg or mg/kg oral IV/IM

other antibiotic prescribed

(please specify) __________________________________________________

DOSE

mg or mg/kg pregnancy or lactation other

Reason for selection drug allergy adverse reaction to first-line drug(s) treatment failure using first-line drug(s)

Please turn over and continue with Q12.

Clinical audit enrolment form

Clinical audit

Antibiotic use in urinary tract infection

Aims of this clinical audit
Completing this clinical audit cycle offers you the opportunity to: review your prescribing of antibiotics for uncomplicated urinary tract infection compare your practice with the recommendations provided in Therapeutic Guidelines: Antibiotic, Version 12, 2003 and with the practice of other participating doctors.

What this audit involves

As patients present for consultation or from a search of your medical records, identify 20 patients who have been diagnosed with either: asymptomatic bacteriuria acute cystitis (lower urinary tract infection) acute pyelonephritis. Complete a clinical audit form for each patient. Participation in this clinical audit requires agreement to aggregation of de-identied patient data.

Continuing professional development points and PIP

NPS has applied for professional development points in the 20052007 triennium of the RACGP Quality Assurance and Continuing Professional Development Program (QA&CPD) and the ACRRM Professional Development Program. This is the second clinical audit offered by NPS which qualies for the Quality Prescribing Initiative (QPI) of the Practice Incentives Program (PIP) for May 2005 to April 2006.

Completing the clinical audit cycle

Review individual and aggregate results and commentary. Record patients progress. Identify where improvement in patient management has occurred.

This Clinical Audit activity has been approved by the RACGP QA&CPD Program. TOTAL POINTS for Steps 15: 30 (Category 1)

IMPORTANT

To enrol
Fill out the form on the reverse then return to NPS to recieve your free audit pack.

Clinical audit enrolment form

Antibiotic use in urinary tract infection
To enrol
Fill out the form below then return to NPS. Enrolments must be received at NPS by Friday 12 August 2005.

Submission date for your audit

Completed clinical audit forms must be submitted to NPS by Friday 9 September, 2005. Unfortunately, late submissions cannot be accepted.

For more information:

Kim Barry Chris Abbu

Phone: 02 8217 8700 Fax: 02 9211 7579 Email: info@nps.org.au

Your details:
Please use BLOCK LETTERS

Doctors rst name Family name Phone number Fax number Postal address

( (

) )

Suburb/town State Postcode

After you have enrolled, your free audit pack will be posted to you. To see a sample audit form before enrolling, visit our website at www.nps.org.au/healthpro. Enrolments must be received at NPS by Friday 12 August, 2005.

Fax this completed form to (02) 9211 7579

OR

Post to: NPS, PO Box 1147, STRAWBERRY HILLS NSW 2012

NPSF0298