Operational Research Improves Compliance with Treatment Guidelines for Empirical Management of Urinary Tract Infection: A Before-and-After Study from a Primary Health Facility in Ghana.

Abstract

Compliance with standard treatment guidelines (STGs) for the empirical management of uncomplicated urinary tract infections (UTIs) ensures the rational use of antibiotics and mitigates antimicrobial resistance. Operational research (OR) at Korle Bu Polyclinic in Ghana (2022) showed suboptimal STG compliance (prescription of recommended antibiotics in the correct dose, route, frequency, and duration). Some of the recommendations from the OR, including training of medical residents, implementation of an antimicrobial stewardship team, and an audit-feedback system, were implemented. This before-and-after study compared the changes in empirical prescribing practices for patients diagnosed with uncomplicated UTIs before (October 2019-October 2021) and after (January 2023-December 2024) the OR. Of the 3717 and 3457 UTI patients in the before and after cohorts, 83% and 86% received empirical antibiotics, respectively. Among those who received empirical antibiotics, STG compliance increased from 60% to 66% (p-value < 0.001). However, STG compliance remained significantly lower among males (18%) compared to females (85%) in the after cohort, as 80% of males were prescribed antibiotics for a shorter period than the recommended 10-14 days. Moving forward, the training and audit-feedback system should emphasize longer antibiotic durations for males with UTI. Given its positive impact, the OR's approach warrants replication for other disease conditions.