An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

Abstract

BackgroundIn 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices.MethodsWe performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration.ResultsWe identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with >75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers.ConclusionsInappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

Treatment of Cystitis by Hungarian General Practitioners: A Prospective Observational Study

“…Short-course oral antibacterial treatment has been proven to be as effective as long courses of antibiotics in the ambulatory management of LUTIs (Dawson-Hahn et al, 2017). However, in our study only 1 in 3 patients with uncomplicated cystitis received a short-term antibiotic course, a finding similar to other studies (Llor et al, 2011;Denes et al, 2012;Hawker et al, 2014;Durkin et al, 2018;Phamnguyen et al, 2019). This may be explained by the fact that pharmacies can dispense only complete boxes of medicines instead of a certain number of tablets actually needed,…”

“…Similar rates for fluoroquinolone use in cystitis (22%) was reported for Belgium (Tyrstrup et al, 2017). In contrast, a relatively frequent fluoroquinolone use (30% of all cases) in uncomplicated UTI has been reported from the US recently, and this rate was even higher in the preceding years (Durkin et al, 2018;Cowart et al, 2019). The decreasing trend is explained by the publication of an FDA black box warning on fluoroquinolones in 2016 (Cowart et al, 2019).…”

Evaluation of the trends and appropriateness of fluoroquinolone use in the outpatient treatment of acute uncomplicated cystitis at five family practice clinics

“…Additionally, providers at other facilities throughout the nation may receive more education or utilize facility‐specific protocols. By expanding our sample population to other military or non‐military facilities, we would be able to study the effect of providers from diverse educational backgrounds; however, we believe the impact of this to be low given that our data showing high rates of inappropriate FQ use are consistent with previous reports worldwide . Furthermore, our study was retrospective; therefore, our data are limited to what was documented in the EMR.…”

Ciprofloxacin, amoxicillin, and aminoglycosides stimulate genetic and phenotypic changes in uropathogenic Escherichia coli strains

“…The exclusion of fluoroquinolones from routine treatment in outpatient therapy and searching for alternatives should be considered. The application of fluoroquinolones is becoming increasingly questionable and the limitation of their use is promoted by many scientists [7,[9][10][11][12]48,49]. In turn, ciprofloxacin induced cross-resistance to the smallest number of antibiotics in comparison to others.…”

“…This group of pathogens exhibit a high capacity to resistance to modern therapies. There are often responsible for frequent recurrent infections as well as fast drug-resistance build-up [49]. The ability to form an intracellular biofilm is a way to cause permanent presence in the urinary tracts of infected patients, which can lead to severe damage or destruction of this system.…”