Antibiotic prescribing patterns for adult urinary tract infections within emergency department and urgent care settings

Maddali, Navya; Cantin, Amanda; Koshy, Sanjana; Eiting, Erick; Fedorenko, Marianna

doi:10.1016/j.ajem.2020.09.061

Cited by 8 publications

(6 citation statements)

References 37 publications

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“…It has previously been shown that clinicians in obstetrics and gynecology and urology have higher rates of IDSA guideline concordance 9 and emergency medicine has lower rates 23,24 ; however, the results of this study are not consistent with those findings. Clinicians in internal medicine, primary care, and emergency medicine had higher IDSA guideline-concordance rates and urology had lower IDSA guideline-concordance rates.…”

Section: Discussioncontrasting

confidence: 99%

Antibiotic Prescribing Patterns and Guideline Concordance for Uncomplicated Urinary Tract Infections Among Adult Women in the US Military Health System

2022

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IMPORTANCEUrinary tract infections (UTIs) are one of the most commonly diagnosed infections, and prior studies have reported discordance in antibiotic treatment with the Infectious Diseases Society of America (IDSA) guidelines. OBJECTIVE To assess IDSA guideline concordance rates for women with uncomplicated UTIs treated with antibiotics, and compare concordance rates between different specialty field. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional study of health care claims data from the US Military Health System Data Repository, which contains comprehensive health care encounter and claims data for all military beneficiaries. Participants were adult women between the ages of 18 to 50 years with uncomplicated UTIs from October 1, 2017, to September 30, 2019. Data extraction and analysis were performed in 2022. Patients with diagnosis of UTI in the preceding 6 months, current pregnancy, history of pyelonephritis, history of diabetes, history of organ transplant, history of human immunodeficiency virus, immunosuppression, renal insufficiency, urinary tract abnormalities, or history of urologic procedures were excluded. EXPOSURES Antibiotic treatment for uncomplicated UTIs. Only antibiotics received within 1 day after the diagnosis were analyzed. The IDSA recommends the following antibiotics as first-line therapy: nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin, pivmecillinam. MAIN OUTCOMES AND MEASURES The IDSA guideline concordance rates were calculated as the number of patients receiving first-line antibiotic therapy divided by the total number of cases for uncomplicated UTIs. RESULTS A total of 46 793 adult women (67.3% [31 475 of 46 793] aged 18-34 years; 38.2% [31 475 of 46 793] of White race) were diagnosed with uncomplicated UTIs with 91.0% receiving guidelineconcordant antibiotic treatment. In comparison with obstetrics and gynecology, IDSA guidelineconcordant treatment was more likely in internal medicine (adjusted odds ratio [aOR], 2.87; 95% CI,

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Section: Discussioncontrasting

confidence: 99%

Antibiotic Prescribing Patterns and Guideline Concordance for Uncomplicated Urinary Tract Infections Among Adult Women in the US Military Health System

2022

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“…coli to ciprofloxacin in community-acquired UTI in the female population aged 15 to 60 years [ 62 ]. Our data indicate that ciprofloxacin was the most common antimicrobial agent prescribed in all cases of UTIs, which is similar to other studies [ 31 , 45 , 59 , 60 ]. The factors influencing the choice of antibiotics by practitioners were not evaluated and are beyond the scope of our research.…”

Section: Discussionsupporting

confidence: 92%

“…Antibiotic usage in UTI cases displays significant variation; according to existing literature, the most frequently utilized antibiotics include ciprofloxacin (17%–36.4%), TMP-SMX (14.2%–26.3%), nitrofurantoin (20.4%–35.9%), fosfomycin (0.2%–16.1%), and cephalosporins (4.8%–20.1%) [ 31 , 45 , 59 , 60 ]. This variation in antibiotic use can be attributed to the presence and adherence to local and international guidelines, individual prescriber preferences, patient-specific factors, and the local availability of antibiotics [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador

Sánchez,

Latacunga,

Cárdenas

et al. 2023

PLoS ONE

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Background Urinary tract infections (UTI) are among the most common cause to prescribe antibiotics in primary care. Diagnosis is based on the presence of clinical symptoms in combination with the results of laboratory tests. Antibiotic therapy is the primary approach to the treatment of UTIs; however, some studies indicate that therapeutics in UTIs may be suboptimal, potentially leading to therapeutic failure and increased bacterial resistance. Methods This study aimed to analyze the antibiotic prescription patterns in adult patients with suspected UTIs and to evaluate the appropriateness of the antibiotic prescription. This is a cross-sectional study of patients treated in outpatient centers and in a second-level hospital of the Ministry of Public Health (MOPH) in a city in Ecuador during 2019. The International Classification of Disease Tenth Revision (ICD-10) was used for the selection of the acute UTI cases. The patients included in this study were those treated by family, emergency, and internal medicine physicians. Results We included a total of 507 patients in the analysis and 502 were prescribed antibiotics at first contact, constituting an immediate antibiotic prescription rate of 99.01%. Appropriate criteria for antibiotic prescription were met in 284 patients, representing an appropriate prescription rate of 56.02%. Less than 10% of patients with UTI had a urine culture. The most frequently prescribed antibiotics were alternative antibiotics (also known as second-line antibiotics), such as ciprofloxacin (50.39%) and cephalexin (23.55%). Factors associated with inappropriate antibiotic prescribing for UTIs were physician age over forty years, OR: 2.87 (95% CI, 1.65–5.12) p<0.0001, medical care by a general practitioner, OR: 1.89 (95% CI, 1.20–2.99) p = 0.006, not using point-of-care testing, OR: 1.96 (95% CI, 1.23–3.15) p = 0.005, and care at the first level of health, OR: 15.72 (95% CI, 8.57–30.88) p<0.0001. Conclusions The results of our study indicate an appropriate prescription rate of 56.02%. Recommended antibiotics such as nitrofurantoin and fosfomycin for UTIs are underutilized. The odds for inappropriate antibiotic prescription were 15.72 times higher at the first level of care compared to the second. Effective strategies are needed to improve the diagnosis and treatment of UTIs.

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“…The review confirms that characteristics of patients matter when it comes to prescription decisions. Antimicrobials are more often prescribed to males, 49 , 61 , 62 patients with a chronic complex condition 63 and comorbidities, 59 , 64 patients with a history of smoking, 65 , 66 patients who report a longer duration of symptoms or worsening symptoms, 62 and older patients, 60 , 67 including in paediatric contexts. 44 Additionally, there are substantial ethnic and racial differences among patients receiving antibiotic prescription, with non-whites 65 , 68 , 69 and patients with indigenous backgrounds 60 being prescribed antibiotics more frequently.…”

Section: Behavioural Analysis Of the Factors Underlying Prescription ...mentioning

confidence: 99%

A scoping review and behavioural analysis of factors underlying overuse of antimicrobials

Poluektova

Robertson

Rafferty

et al. 2023

JAC-Antimicrobial Resistance

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Background Overuse of antimicrobials is a challenging global issue that contributes to antimicrobial resistance. Despite widespread awareness of the problem among members of the medical community and various attempts to improve prescription practices, existing antimicrobial stewardship programmes are not always effective. In our view, this may reflect limited understanding of factors that influence prescription of antimicrobials as empirical therapy, implying a need to address the psychological mechanisms behind some of the specific behaviours involved. Objectives To identify factors that influence the antimicrobials prescription as empirical therapy, and to relate these factors to findings from behavioural science. Methods We conducted a scoping review of the literature on the factors underlying antimicrobial prescription decisions, following the protocol designed using PRISMA guidelines. Results and conclusions From a final sample of 90 sources, we identified ten factors important in antimicrobial prescription decisions. In the second stage of our analysis, we grouped them into five final categories: (1) nature of the decision, (2) social influences, (3) individual differences, (4) characteristics of the patient, (5) context. We analyse these categories using a behavioural science perspective.

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Antibiotic prescribing patterns for adult urinary tract infections within emergency department and urgent care settings

Cited by 8 publications

References 37 publications

Antibiotic Prescribing Patterns and Guideline Concordance for Uncomplicated Urinary Tract Infections Among Adult Women in the US Military Health System

Antibiotic Prescribing Patterns and Guideline Concordance for Uncomplicated Urinary Tract Infections Among Adult Women in the US Military Health System

Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador

A scoping review and behavioural analysis of factors underlying overuse of antimicrobials

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