Prescribing pattern of antibiotics and guideline adherence in acute community-acquired uncomplicated urinary tract infections in Pakistani women

Abstract

Aim: Acute urinary tract infection is one of the most predominant community-acquired infections. These infections are often treated with antibiotics, but its inappropriate usage leads to Clostridium difficile infections, resistance development and higher cost. To evaluate the prescribing pattern of antibiotic and adherence to Infectious Diseases Society of America (IDSA) guidelines in uncomplicated urinary tract infections (cystitis and pyelonephritis) among females. Material and Method: A retrospective, chart-review study was conducted in a teaching hospital in Pakistan. Consecutively two hundred (n=200; cystitis: n=100, pyelonephritis: n=100) medical charts of female patients kept for the last 1 year (May 2018 to April 2019) were enrolled through random systematic sampling technique. Important information was extracted from medical charts and compared with IDSA recommendations. Finally, collected data were entered into SPSS, version 22.0 for statistical analysis, such as; frequency, percentage and chi-square test. A p-value < 0.05 was considered statistically significant. Results: The most frequently prescribed antibiotic was ciprofloxacin (58, 29%), followed by nitrofurantoin (39, 19.5%) and ceftriaxone (32, 16%). About, 86 (43%) patients received an appropriate antibiotic. The dose was given according to the guidelines in 84.5% of patients, whereas the duration of prescribed antibiotic was appropriate in 61% of the patients, with a significant inappropriate dose and duration in pyelonephritis patients. A total of 58 patients were completely correct in all steps (drug, dose and duration). The appropriate prescribing of antibiotic with respect to selection/choice, dose and duration were more in cystitis as compared to pyelonephritis (P=0.001). Conclusions: A low adherence rate with guidelines was observed. Real actions are needed for educative interventions and implementation of standard guidelines for the improved good prescribing practices of antibiotic and better care of patients.