Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland

Hdl Handle:
http://hdl.handle.net/10147/567102
Title:
Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland
Authors:
Vellinga, Akke; Cormican, Martin; Hanahoe, Belinda; Bennett, Kathleen; Murphy, Andrew W
Citation:
BMC Family Practice. 2011 Oct 03;12(1):108
Issue Date:
3-Oct-2011
URI:
http://dx.doi.org/10.1186/1471-2296-12-108; http://hdl.handle.net/10147/567102
Abstract:
Abstract Background Urinary tract infections (UTIs) are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice. Methods Management of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample. Results A total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI. An antimicrobial agent was prescribed to 56% (481) of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%), trimethoprim (26%) and fluoroquinolones (17%). Variation between practices in antimicrobial prescribing as well as in their preference for certain antimicrobials, was observed. Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients given an antimicrobial or treatment with ciprofloxacin in all patients. Prescribing cost was lower for nitrofurantoin. Empirical treatment of all patients with trimethoprim only was less effective due to the higher resistance levels. Conclusions There appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.
Language:
en
Keywords:
URINARY TRACT DISEASE; MICROBIOLOGY; GENERAL PRACTICE

Full metadata record

DC FieldValue Language
dc.contributor.authorVellinga, Akkeen
dc.contributor.authorCormican, Martinen
dc.contributor.authorHanahoe, Belindaen
dc.contributor.authorBennett, Kathleenen
dc.contributor.authorMurphy, Andrew Wen
dc.date.accessioned2015-08-17T08:54:06Zen
dc.date.available2015-08-17T08:54:06Zen
dc.date.issued2011-10-03en
dc.identifier.citationBMC Family Practice. 2011 Oct 03;12(1):108en
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2296-12-108en
dc.identifier.urihttp://hdl.handle.net/10147/567102en
dc.description.abstractAbstract Background Urinary tract infections (UTIs) are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice. Methods Management of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample. Results A total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI. An antimicrobial agent was prescribed to 56% (481) of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%), trimethoprim (26%) and fluoroquinolones (17%). Variation between practices in antimicrobial prescribing as well as in their preference for certain antimicrobials, was observed. Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients given an antimicrobial or treatment with ciprofloxacin in all patients. Prescribing cost was lower for nitrofurantoin. Empirical treatment of all patients with trimethoprim only was less effective due to the higher resistance levels. Conclusions There appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.en
dc.language.isoenen
dc.subjectURINARY TRACT DISEASEen
dc.subjectMICROBIOLOGYen
dc.subjectGENERAL PRACTICEen
dc.titleAntimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Irelanden
dc.language.rfc3066enen
dc.rights.holderVellinga et al; licensee BioMed Central Ltd.en
dc.date.updated2015-08-14T13:26:34Zen
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