Compliance can be improved by the introduction of user-friendly drug packaging, especially for more complex dosing regimens.
Background Uncomplicated urinary tract infections (uUTI) are generally treated empirically with antibiotics. However, antibiotic (AB) allergies limit the available oral treatment options for some patients. We assessed the proportion of self-reported AB allergies among US females with uUTI. Methods We performed a cross-sectional survey of US females ≥ 18 years of age with a self-reported urinary tract infection (UTI) in the 60 days prior to participation and a prescription of oral AB. Participants were further screened for evidence of a complicated urinary tract infection and, after exclusions, participants with a uUTI completed an online questionnaire about their most recent episode. Participants were from the Northeast (20%), Midwest (44%), South (20%), and West (16%) US. Descriptive self-reported allergy data were stratified into subgroups by whether the participant had recurrent UTI (defined as ≥ 2 uUTIs in the past 6 months or ≥ 3 uUTIs in past 12 months including index UTI), the number of different ABs given for the index episode (1, 2, ≥ 3), and whether the treatment was clinically appropriate according to Infectious Diseases Society of America uUTI guidelines. Results Overall, 375 female participants completed the questionnaire. The most commonly prescribed ABs for participants’ most recent uUTI were trimethoprim-sulfamethoxazole (TMP-SMX; 38.7%), ciprofloxacin (22.7%), and nitrofurantoin (18.9%) (Table 1). Most participants received only 1 AB for their uUTI (62.7%) and the majority were classified as having a non-recurrent uUTI (56.5%). No AB allergies were reported for most participants (69.3%); overall, 24.0% reported 1 AB allergy and 6.7% reported ≥ 2. A higher proportion of participants reported ≥ 2 allergies in the recurrent uUTI, ≥ 3 AB, and multiple AB subgroups (Table 2). The most common allergy was to TMP-SMX (15.7%), followed by amoxicillin-clavulanate (8.3%) and ciprofloxacin (5.3%) (Table 2). Similar allergy trends were seen across subgroups, except higher rates of ciprofloxacin allergy were seen in participants given multiple ABs (Table 2). Table 1. Antibiotics used to treat most recent uUTI Table 2 . Frequency of antibiotic allergies across cohort subgroups Conclusion AB allergies were relatively frequent in this uUTI cohort and the most common allergy was to TMP-SMX, which was the most prescribed AB. Allergies to ABs reduce the available treatment options for uUTI in some patients. Disclosures Jeffrey Thompson, PhD, Kantar Health (Employee, Employee of Kantar Health, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Jonathon Wright, BSc, Kantar Health (Employee, Employee of Kantar Health, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)
Background Uncomplicated urinary tract infections (uUTI) are among the most common infections in women; however, there are few data on the impact of uUTIs on daily activity and health-related quality of life (HRQoL). Methods This was a prospective, cross-sectional survey of US females aged ≥ 18 years with a self-reported uUTI in the 60 days prior to participation. Participants were included if they received oral antibiotic treatment and participated in surveys fielded by Dynata, Lucid/Federated, or Kantar Profiles. See Table 1 for inclusion/exclusion criteria. Study objectives were to describe activity impairment (using the Activity Impairment Assessment [AIA]) and HRQoL (assessed with Short Form 36 version 2, Physical Component Score [PCS], Mental Component Score [MCS], and health utility index [SF-6D]) associated with uUTI. After screening, participants completed an online questionnaire on their most recent uUTI. Outcomes were reported with descriptive statistics, chi-squared tests, and t-tests. Analysis of HRQoL used 1:1 propensity score matching to compare to a matched US population from the 2020 National Health and Wellness Survey. Table 1. Inclusion and exclusion criteria Results In total, 375 participants completed the questionnaire. Common impaired activities were: sexual intercourse (66.9%), sleep (60.8%), exercise (52.3%), housework (51.5%), and social activities (46.9%; Table 2). Overall mean AIA score was 11.1/20 (higher score = more impairment). Most participants (58.7%) had a PCS that was the same or better than the matched population, while for MCS, most participants (52.8%) had scores well below the matched population average. Overall PCS, MCS, and SF-6D composite scores were 46.5, 40.0, and 0.63, respectively; these outcomes were significantly worse compared to the matched population, most notably MCS (Table 3). Stratification by number of antibiotics used revealed statistically significant differences in the effect of uUTI on exercise, PCS, SF-6D (based on use of 1 or ≥ 3 therapies), and on sleep (based on use of 2 or ≥ 3 therapies; Table 4). Table 2. Activities impacted by uUTI Table 3. Matched analysis of SF-36v2-measured HRQoL outcomes Table 4. Outcomes stratified by number of oral antibiotics used to treat last uUTI Conclusion uUTIs are significantly associated with adverse patient outcomes for daily activities and HRQoL, compounded by suboptimal treatment evident by the use of multiple antibiotics. MCS was notably affected, which is important as this is not often studied in uUTI. Disclosures Jeffrey Thompson, PhD, Kantar Health (Employee, Employee of Kantar Health, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Jonathon Wright, BSc, Kantar Health (Employee, Employee of Kantar Health, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)
Background Uncomplicated urinary tract infections (uUTI) account for a large proportion of primary care antibiotic (AB) prescriptions. This study assessed uUTI-related healthcare resource use (HRU) and costs in US females with a self-reported uUTI. Methods We surveyed US females aged ≥ 18 years who participated in web-based surveys (fielded August 28–September 28, 2020 by Dynata, EMI, Lucid/Federated, and Kantar Profiles). Participants had a self-reported uUTI ≤ 60 days prior, and took ≥ 1 oral AB for their uUTI. Those reporting signs of complicated UTI were excluded. HRU was measured via self-reported primary care provider (PCP), specialist, urgent care, emergency room (ER) visits, and hospitalizations. Direct costs were calculated as sum of self-reported and HRU monetized with Medical Expenditure Panel Survey estimates. Indirect costs were calculated via Work Productivity and Impairment metrics monetized with Bureau of Labor Statistics estimates. Participants were stratified by number of oral ABs prescribed (1/2/3+) and therapy appropriateness (1 AB [1st line/2nd line]/multiple [any line] AB) for most recent uUTI. Multivariable regression modeling was used to compare strata; 1:1 propensity score matching assessed uUTI burden vs matched population (derived from the 2020 National Health and Wellness Survey [NHWS]). Results In total, 375 participants were eligible for this analysis. PCP visits (68.8%) were the most common HRU. Across participants, there were an average of 1.46 PCP, 0.31 obstetrician/gynecologist, 0.41 urgent care and 0.08 ER visits, and 0.01 hospitalizations for most recent uUTI (Table 1). Total mean uUTI-related direct and indirect costs were &1289 and &515, respectively (Table 1). Adjusted mean total direct costs were significantly higher (Table 2) for participants in the ‘2 AB’ cohort vs the ‘1 AB’ cohort (&2090 vs &776, p < 0.0001), and for the ‘multiple AB’ vs ‘1 AB, 1st line’ cohorts (&1642 vs &875, p=0.002). Participants in the uUTI cohort reported worse absenteeism (+15.3%), presenteeism (+46.5%), overall work impairment (+52.4%), and impact on daily activities (+50.7%) vs NHWS cohort (p < 0.0001, Table 3). Table 1. Overall mean uUTI-related healthcare resource use, direct, and indirect cost data Table 2. Estimated uUTI-related direct costs stratified by (A) number of AB and (B) appropriateness of AB therapy used to treat last uUTI Table 3. Mean Work Productivity and Activity Impairment data for uUTI and NHWS cohorts Conclusion Inadequate treatment response, evident by multiple AB use, was associated with an increase in uUTI-related costs, including productivity loss. Disclosures Jeffrey Thompson, PhD, Kantar Health (Employee, Employee of Kantar Health, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Jonathon Wright, BSc, Kantar Health (Employee, Employee of Kantar Health, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)
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