Antimicrobial prescription practices for outpatients with uncomplicated cystitis in Japan

Abstract

To promote antimicrobial stewardship, we studied antimicrobial prescription rates for uncomplicated cystitis, a common outpatient disease requiring antibiotic treatment. This multicenter retrospective study was performed from January 1, 2018, to December 31, 2020, in Japan, targeting outpatients aged ≥ 20 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting uncomplicated cystitis (N300). The data of 1445 patients were collected and that of 902 patients were analyzed. The overall median patient age was 71 years and a proportion of those aged less than 50 years was 18.8% with a female dominance (82.6%). Antimicrobials were prescribed for 884 patients (98.0%) and a total of 623 patients (69.1%) were treated with broad-spectrum drugs, including fluoroquinolones (36.0%), third-generation cephalosporins (29.9%) and faropenem (3.1%). A logistic regression model revealed that the broad-spectrum agents were significantly prescribed for the older patients, male patients, and those who visited internists. Recurrence was observed in 37 (4.1%) cases, and the multivariate analysis suggested any of age, sex, or antimicrobial types were not associated with the recurrence. Collectively, approximately two-thirds of antimicrobials prescribed for uncomplicated cystitis were broad-spectrum agents. The present data would be an indicator for antimicrobial prescriptions in uncomplicated cystitis in Japan.

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

“…Despite the fortuitous successful OAT of a high proportion of cases, this approach may produce failures and accentuate the evolution of AMR and the complications we observe in clinical services. The extrapolation of clinical experience in the treatment of bacterial infections in other parts of the body to cystitis should be re-evaluated in light of the pharmacokinetic considerations described here as an essential feature of AMS [110]. Based on the current understanding of the adaptability of uropathogens, we deign to hypothesize that any antibacterial treatment protocol [124] that fails to account for the evolutionary predisposition of microbes that have been adapting to climate change for billions of years [4] may be destined to fail the test of time.…”

“…Opportunities-predictable oral bioavailability [30,101,102,109] could reduce the delay in achieving urinary MIC [28,105], and informed clinical practices [110,111] 13, 328 7 of 21 iatrogenic renal toxicity in patients with oliguria, lower creatinine clearance [107], resulting in the overdosing of OAT [113], environmental changes accelerating AMR [4], and the development of non-antibiotic approaches [13,14,19,20,[114][115][116][117].…”

“…Opportunities-predictable oral bioavailability [30,101,102,109] could reduce the delay in achieving urinary MIC [28,105], and informed clinical practices [110,111] could counter the emergence of AMR.…”