Practitioner Education and Feedback to Decrease Ciprofloxacin Prescriptions in Patients with Acute Uncomplicated Cystitis

Guo, Richard F; Nguyen, Duc‐Tho; Park, Steven; Nguyen, Kristen; Ko, Steven; Chiu, Vicki; Dickter, Jana; Becker, Davida; Cho, Philomena

doi:10.7812/tpp/18.036

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…The prescribing impact from the UAC portrait was greater than previous portraits implemented by the EQIP initiative [ 17 ], and was comparable with similar antimicrobial audit and feedback initiatives [ 20 ]. For example, a practitioner education and feedback intervention in California achieved a 71% decrease in ciprofloxacin treatment for UAC (adjusted odds ratio = 0.29, 95% CI: 0.20–0.44) [ 21 ]. Another pharmacist-led audit and feedback project in the primary care setting in the state of Michigan was able to improve guideline-concordant prescribing for UTIs from 20% at baseline to a median of 69.2% [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians

Carney,

Maclure,

Patrick

et al. 2023

PLoS ONE

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Objective To evaluate the impact of personalized prescribing portraits on antibiotic prescribing for treating uncomplicated acute cystitis (UAC) by Family Physicians (FPs). Design Cluster randomized control trial. Setting The intervention was conducted in the primary care setting in the province of BC between December 2010 and February 2012. Participants We randomized 4 833 FPs by geographic location into an Early intervention arm (n = 2 417) and a Delayed control arm (n = 2 416). Intervention The Education for Quality Improvement in Patient Care (EQIP) program mailed to each FP in BC, a ‘portrait’ of their individual prescribing of antibiotics to women with UAC, plus therapeutic recommendations and a chart of trends in antibiotic resistance. Main outcome measures Antibiotic prescribing preference to treat UAC. Results Implementing exclusion criteria before and after a data system change in the Ministry of Health caused the arms to be unequal in size–intervention arm (1 026 FPs, 17 637 UAC cases); control arm (1 352 FPs, 25 566 UAC cases)–but they were well balanced by age, sex and prior rates of prescribing antibiotics for UAC. In the early intervention group probability of prescribing nitrofurantoin increased from 28% in 2010 to 38% in 2011, a difference of 9.9% (95% confidence interval [CI], 9.1% to 10.7. Ciprofloxacin decreased by 6.2% (95% CI: 5.6% to 6.9%) and TMP-SMX by 3.7% (95% CI: 3.1% to 4.2%). Among 295 FPs who completed reflective surveys, 52% said they were surprized by the E. coli resistance statistics and 57% said they planned to change their treatment of UAC. Conclusion The EQIP intervention demonstrated that feedback of personal data to FPs on their prescribing, plus population data on antibiotic resistance, with a simple therapeutic recommendation, can significantly improve prescribing of antibiotics. Trial registration: ISRCTN 16938907.

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Section: Discussionmentioning

confidence: 99%

A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians

Carney,

Maclure,

Patrick

et al. 2023

PLoS ONE

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The best rules for antimicrobial stewardship in urogenital tract infections

Kulchavenya

2020

Current Opinion in Urology

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Purpose of review Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections, but therapy of UTIs is limited by resistance of pathogens and nonoptimal using of antibacterials. Narrative review of recent (2020–2018) literature dedicated to antimicrobial stewardship (AMS) in urological infections has been done. Recent findings Analysis of recent 64 articles has shown following principles of AMS for UTIs: selecting the correct drug, correct dose, and shortest clinically effective duration of therapy whenever possible, is a base for optimal antimicrobial stewardship; symptomatic UTIs should be treated with antimicrobials to alleviate symptoms, and in the case of more serious infection, to prevent complications; in both symptomatic and asymptomatic infection, quantitative culture is the gold standard for diagnosis; we have to avoid prescriptions of antibiotics when possible; we have to follow European and National Guidelines; we must avoid prescription of fluoroquinolones as empiric therapy for UTIs by many reasons, one of these is urogenital tuberculosis; the choice of antibiotic for UTI should be based on local level of resistance of uropathogens. Summary Studies of antimicrobial stewardship in urology are limited. Nevertheless, there are some golden rules, which may help to reduce inappropriate use of antimicrobials, improve patient outcomes, reduce side effects of antibiotic therapy, decrease the emergence and spread of multidrug-resistant infections, as well as decrease total costs of the therapy.

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Long-term impact of fluoroquinolone-sparing strategies for empirical treatment of acute uncomplicated cystitis among ambulatory patients

Kon

Meslovich

Valdez

et al. 2022

Therapeutic Advances in Infection

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Background: Acute uncomplicated cystitis is common among outpatients and frequently leads to antibiotic prescriptions, making urinary tract infections (UTIs) an important area for antimicrobial stewardship initiatives. Infectious Disease Society of America (IDSA) guidelines promote alternative agents in place of fluoroquinolones for acute uncomplicated cystitis. Despite IDSA guidance, adherence to the guideline remains low in the United States (US). Several studies have described interventions to improve guideline-concordant prescribing for UTIs. However, the long-term sustainability and impact of fluoroquinolone (FLQ)-sparing strategies on community antimicrobial resistance and treatment outcomes are unknown. The objectives of this study were to characterize current antibiotic prescribing patterns, treatment failures and Escherichia coli resistance rates in a setting which instituted FLQ sparing strategies for UTIs in 2007. Methods: Retrospective cohort study of women aged ⩾ 18 diagnosed with acute uncomplicated cystitis based on International Classification of Diseases, 10th Revision (ICD-10) codes were included. Data were abstracted for ambulatory visits over a 6-month period, January 2018 to June 2018, at a large urban health care system. Treatment decisions were made by individual providers, and data were analyzed retrospectively. Nitrofurantoin (NFT) resistance was obtained from the institutional antibiogram and patient-level data. Treatment failure was defined as the need for a different antibiotic for UTI within 28 days of the original prescription. Results: NFT was the most frequently prescribed antibiotic ( n = 386, 71.6%) of empiric antibiotic prescriptions for UTIs. FLQs comprised 4.6% of all antibiotic prescriptions ( n = 25). Treatment failure rate was 2.3% in patients treated with NFT. Urine culture was ordered for only 26.8% of patients. Among the small group of patients with cultures ordered, E. coli remained 98.5% susceptible to NFT. Conclusions: This study is the first to report significantly low rates (4.6%) of FLQ prescribing for acute uncomplicated cystitis. Treatment failure rate was low with empiric NFT. Increased NFT resistance among E. coli was not observed at the institution or among the subset of patients with E. coli positive urine cultures. These findings support current IDSA treatment guidance for uncomplicated cystitis.

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Practitioner Education and Feedback to Decrease Ciprofloxacin Prescriptions in Patients with Acute Uncomplicated Cystitis

Cited by 3 publications

References 17 publications

A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians

A cluster randomized trial assessing the impact of personalized prescribing feedback on antibiotic prescribing for uncomplicated acute cystitis to family physicians

The best rules for antimicrobial stewardship in urogenital tract infections

Long-term impact of fluoroquinolone-sparing strategies for empirical treatment of acute uncomplicated cystitis among ambulatory patients

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