Abstract
BackgroundUrinary tract infections are one of the most common reasons for prescribing antibiotics in primary care. Current guidelines recommend fosfomycin, nitrofurantoin, or trimethoprim - sulfamethoxazol as empiric first line antimicrobial agents in uncomplicated infections. However, there is evidence that the use of fluoroquinolones, which are no longer recommended, is still inappropriate high. We determined antibiotic prescription patterns, quality and factors affecting antibiotic prescriptions in urinary tract infections in primary care in Switzerland.MethodsFrom June 2017 to August 2018, we conducted a cross-sectional study in patients suffering from a urinary tract infection (UTI). Patient and general practitioners characteristics as well as antibiotic prescribing patterns were analysed.ResultsAntibiotic prescribing patterns in 1.352 consecutively recruited patients, treated in 163 practices could be analysed. In 950 (84.7%) patients with an uncomplicated UTI the prescriptions were according to current guidelines and therefore rated as appropriate. Fluoroquinolones were prescribed in 13.8% and therefore rated as inappropriate. In multivariable analysis, the age of the general practitioner was associated with increasing odds of prescribing a not guideline recommended antibiotic therapy.ConclusionsWe found a high degree of guideline conform antibiotic prescriptions in patients with an uncomplicated urinary tract infection in primary care in Switzerland. However, there is still a substantial use of fluoroquinolones in empiric therapy.
Highlights
Urinary tract infections are one of the most common reasons for prescribing antibiotics in primary care
Empirical treatment of a uUTI with fosfomycin, nitrofurantoin or Trimethoprim -sulfamethoxazol (TMP/SMX) were considered as adequate according to national guidelines [4]
Basic characteristics of the conducting general practitioners (GP) are described in Table 1. 1210 (90.4%) patients had a diagnosis of a uUTI and 129 (9.6%) of a complicated UTI (cUTI). 94.9% of the patients were female and the mean age was 54 years (Table 2)
Summary
Urinary tract infections are one of the most common reasons for prescribing antibiotics in primary care. Despite their undisputed efficacy in the treatment of UTI, their excessive use in the last decades resulted in raising resistances in uropathogens, and in pathogens causing extraurogenital infections [5]. Due to their importance in the treatment in extra-urogenital infections, the use of FC as an empiric first line antimicrobial agent in uUTI is no longer recommended [5, 6, 9]. FC use is associated with further serious adverse effects (for example tendinitis and tendon rupture, and prolonged QTc, or Clostridium difficile associated diarrhoea) and both the US Food and Drug Administration and the European Medicines Agency released warnings and called for a more restrictive FC use [10, 11]
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