Abstract
Objective: The aim of this study was to describe and characterize the prescription of antibiotics for urinary tract infection (UTI) in general practice in Denmark and to evaluate compliance with current recommendations.Design: National registry-based studySetting: Danish general practicePatients: 267.539 patients who redeemed a prescription for antibiotics with the clinical indication UTI at community pharmacies between July 1st 2012 and June 31st 2013.Main outcome measures: Antibiotics prescribed for 1) acute lower UTI, 2) acute upper UTI and 3) recurrent UTI presented as amount of prescriptions, number of treatments per 1000 inhabitants per day (TID) and defined daily doses per 1000 inhabitants per day (DID).Results: A total of 507.532 prescriptions were issued to 267.539 patients during the one year study period, representing 2.35 DID. Acute lower UTI was the most common reason for prescription of antibiotics (89.5%) followed by recurrent UTI (8.4%). The majority of the prescriptions were issued to people above 60 year old (57.6%). Pivmecillinam was the most commonly prescribed antibiotic in acute lower (45.8%) and acute upper (63.3%) UTI. Trimethroprim was the most commonly prescribed antibiotic in recurrent UTI (45.9%). Prescription of quinolones increased with increasing patient-age (p = <.0001).Conclusion: Compliance with current Danish recommendations was moderately high. Pivmecillinam is the first line antibiotic for the management of acute lower and upper UTI, and trimethroprim is the first line option of recurrent UTI. A high proportion of the antibiotic prescriptions were issued in the elderly population including a relatively high prescription rate of quinolones.Key pointsUrinary tract infection (UTI) is a common cause for prescription of antibiotics in general practicePoor compliance in general practice with recommendations for first-line treatment of UTI may increase antibiotic resistanceDanish general practitioners are generally compliant with national and regional guidelines for antibiotic treatment of UTIThere is high use of antibiotics in the elderly population including a worrisome high use of broad-spectrum antibiotics, such as Quinolones.
Highlights
Urinary tract infection (UTI) is a common condition in primary care and the associated costs are significant to the patient as well as society [1,2]
Main outcome measures: Antibiotics prescribed for 1) acute lower UTI, 2) acute upper UTI and 3) recurrent UTI presented as amount of prescriptions, number of treatments per 1000 inhabitants per day (TID) and defined daily doses per 1000 inhabitants per day (DID)
We have previously described use of these clinical indications for assessing antibiotic use and congruence with guidelines on antibiotic use in respiratory tract infections general practice [3]
Summary
Urinary tract infection (UTI) is a common condition in primary care and the associated costs are significant to the patient as well as society [1,2]. UTI is a leading cause for antibiotic prescribing in general practice, second only to respiratory tract infections [3]. UTIs where antibiotics are beneficial from self-limiting UTIs, suggests that a high level of overtreatment is likely [6]. Excessive and inappropriate antibiotic prescribing only serves to increase unwanted side effects and the risk of antibiotic resistance both in individually treated patients and at the societal level [7,8]. In order to improve the use of antibiotics, the prescription of antibiotics for specific conditions must be continuously monitored to effectively implement
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