Beyond antibiotic selection: concordance with the IDSA guidelines for uncomplicated urinary tract infections

Kim, M.; Lloyd, Ann E.; Condren, Michelle; Miller, Michael J.

doi:10.1007/s15010-014-0659-4

Cited by 30 publications

(38 citation statements)

References 7 publications

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“…Two smaller studies, involving a total of 3 outpatient clinics, also demonstrated poor adherence to the IDSA CPG for UTIs [27, 28]. Grigorian et al evaluated 1546 visits for UTI in 2 private family medicine clinics associated with an academic medical center.…”

Section: Discussionmentioning

confidence: 99%

An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

Durkin¹,

Keller²,

Butler

et al. 2018

Open Forum Infectious Diseases

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BackgroundIn 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices.MethodsWe performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration.ResultsWe identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with >75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers.ConclusionsInappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

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Section: Discussionmentioning

confidence: 99%

An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

Durkin¹,

Keller²,

Butler

et al. 2018

Open Forum Infectious Diseases

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“…Our findings regarding the common use of amoxicillin with clavulanate suggest a need to restrict the use of this agent in Australia, a recommendation that was made in a 2015 report by the Australian government . A number of studies in the USA demonstrate a similar finding, whereby the majority of prescribers within the study's sample recommended a non‐first‐line agent (fluoroquinolone) to treat acute uncomplicated cystitis over the first‐line recommendation listed in the Infectious Diseases Society of America guidelines . The specific antibiotic(s) recommended by guidelines are based on the best available evidence, balancing the need to cover the likely causative organisms while preserving broader‐spectrum antibiotics and newer agents for situations where they are truly justified.…”

Section: Discussionmentioning

confidence: 79%

Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior‐to‐hospital therapy

et al. 2019

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Summary BackgroundAppropriate antibiotic prescribing improves patient outcomes and mitigates antimicrobial resistance. As the majority of antibiotics are used in the community, rational prescribing in this setting is of paramount importance. ObjectivesWe aimed to (1) evaluate the concordance of community antibiotic prescribing with guidelines for three common infection types among patients who presented to hospital, and (2) identify relationships between guideline concordance and patient‐related factors. MethodsMedical records were evaluated from the Royal Hobart Hospital (Tasmania, Australia) for patients presenting with respiratory tract, urinary tract or skin and soft tissue infections within a 12‐month period. Prior‐to‐hospital antibiotic therapy was assessed for concordance with prescribing guidelines based on presenting diagnosis. Concordance was assessed against first‐line recommendations in the Australian Therapeutic Guidelines ‐ Antibiotic, based on drug choice, dose, frequency and patient factors. Descriptive statistics were performed to address Objective 1. Multivariate logistic regressions were conducted to address Objective 2 with the following independent variables: infection type, age, allergies, diabetes status, gender and residential setting. ResultsA total of 285 patient records were eligible for data analysis; 28.8% (n = 82) were fully guideline concordant. The most common reason for non‐concordance was inappropriate drug choice (n = 143, 50.2%). Patients with the following characteristics were less likely to receive concordant therapy: diabetes (OR = 0.3, 95% CI 0.1‐0.8, P = .02) and increasing age (OR = 0.99, 95% CI 0.98‐1.00, P = .04). ConclusionsAlmost three‐quarters of patients received community‐initiated antibiotic therapy that was not fully guideline concordant. Antimicrobial stewardship interventions are urgently needed to improve guideline concordance for community‐initiated antibiotic therapy.

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“…In a recent American article investigating the concordance with the IDSA guidelines for uncomplicated UTI found that overall concordance (antibiotic type, dose, frequency, and duration) was 33.96%, 64% of patients were prescribed an antibiotic type concordant with the current IDSA guidelines [30].…”

Section: National Ambulatory Antibiotic Consumption Studymentioning

confidence: 99%

“…Kim et al suggested that amoxicillin-clavulanic acid, cefaclor and cefpodoxime-proxetil are appropriate choices in 3-7 days regimens in the USA only in cases when first-line agents are contraindicated (local antimicrobial resistance or patient allergy) [30]. In Malaysia prescription of cephalosporins (13.3%) dominated over quinolones and the local antibiotic guidelines recommend cefuroxime as an alternative antimicrobial [242].…”

Section: National Ambulatory Antibiotic Consumption Studymentioning

confidence: 99%

“…Consumption of first-, second-and third-generation quinolones for systemic use in the community, EU/EEA countries in 2012 (expressed as DDD per 1 000 inhabitants and per day) [25] The largest volume of antibiotics for systemic use are prescribed in the primary care. The second most common indication for antibiotic use -following the respiratory tract infections -are the urinary tract infections, where antibiotics are usually prescribed in more than 85% of cases [29][30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Hungarian ambulatory antibacterial use in urinary tract infections with different methods

Juhász¹

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Beyond antibiotic selection: concordance with the IDSA guidelines for uncomplicated urinary tract infections

Cited by 30 publications

References 7 publications

An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior‐to‐hospital therapy

Evaluation of the Hungarian ambulatory antibacterial use in urinary tract infections with different methods

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