Adherence to guideline recommendations for urinary tract infections in adult women: a cross-sectional study

Author:

Lelie- van der Zande RianORCID,Bouvy MarcelORCID,Teichert MartinaORCID

Abstract

Abstract Aim: To study whether changes in drug preferences in the Dutch guideline for the treatment of Urinary Tract Infection (UTI) for General Practitioners (GPs) in 2013, resulted in corresponding changes in antibiotic dispensing. Background: For the treatment of uncomplicated UTI, nitrofurantoin remained the first choice, while fosfomycin became the second choice and changed ranks with trimethoprim. For a subsequent febrile UTI, ciprofloxacin became the first choice and changed ranks with amoxicillin/clavulanic acid, co-trimoxazole remained the third choice. Methods: In this observational cross-sectional study, routinely collected dispensing data from the Dutch Foundation of Pharmaceutical Statistics from 2012 to 2017 were used. The number of women 18 years and older, treated with one of the guideline antibiotics for uncomplicated UTI and subsequent febrile UTI were analysed annually. Proportions were calculated. Data were stratified for age categories. Failure of uncomplicated UTI treatment was defined as the dispensing of an antibiotic for febrile UTI within 14 days after the dispensing of an antibiotic for uncomplicated UTI. Findings: Data were available from 81% of all pharmacies in 2012 to 89% in 2017. Percentages of women dispensed nitrofurantoin were relatively stable with 87.4% in 2012 and 84.4% in 2017. Percentages of women dispensed fosfomycin increased from 5.4% in 2012 to 21.8% in 2017, whereas percentages of women dispensed trimethoprim decreased from 17.8% to 8.0%. Within age categories, the percentage of women dispensed fosfomycin increased from 12.4% in women 18–30 years old to 36.7% in women above 80 years old. Percentages of women dispensed antibiotics for febrile UTI remained stable at 5% annually. Percentages of women receiving ciprofloxacin increased from 1.9% in 2012 to 3.3% in 2017, while those receiving amoxicillin/clavulanic acid decreased from 2.9% to 1.8%. New guideline recommendations resulted in corresponding changes in dispensed antibiotics for uncomplicated UTI and subsequent febrile UTI. Drug choices differed for age categories.

Publisher

Cambridge University Press (CUP)

Subject

Care Planning,Public Health, Environmental and Occupational Health

Reference35 articles.

1. Greeff, SCD and Mouton, JW (2019) NethMap 2018: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands/MARAN 2018: Monitoring of Antimicrobial Resistance and Antibiotic Usage in Animals in the Netherlands in 2017. National Institute for Public Health and the Environment. Retrieved from https://www.rivm.nl/bibliotheek/rapporten/2019-0038.pdf

2. Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections

3. Nitrofurantoin vs Fosfomycin

4. Low Concordance With Guidelines for Treatment of Acute Cystitis in Primary Care

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