Consultations and antibiotic treatment for urinary tract infections in Norwegian primary care 2006–2015, a registry-based study

Abstract

Background Extensive use of antibiotics and the resulting emergence of antimicrobial resistance is a major health concern globally. In Norway, 82% of antibiotics is prescribed in primary care and one in four prescriptions are issued for the treatment of urinary tract infections (UTI). The aim of this study was to investigate time trends in antibiotic treatment following a consultation for UTI in primary care. Methods For the period 2006–2015 we linked data from the Norwegian Registry for Control and Payment of Health Reimbursements on all patient consultations for cystitis and pyelonephritis in general practice and out-of-hours (OOH) services, and data from the Norwegian Prescription Database on all dispensed prescriptions of antibiotics. Results Altogether 2,426,643 consultations by attendance for UTI took place in the study period, of these 94.5% for cystitis and 5.5% for pyelonephritis. Of all UTI consultations, 79.4% were conducted in general practice and 20.6% in OOH services. From 2006 to 2015, annual numbers of cystitis and pyelonephritis consultations increased by 33.9 and 14.0%, respectively. The proportion of UTI consultations resulting in an antibiotic prescription increased from 36.6 to 65.7% for cystitis, and from 35.3 to 50.7% for pyelonephritis. These observed changes occurred gradually over the years. Cystitis was mainly treated with pivmecillinam (53.9%), followed by trimethoprim (20.8%). For pyelonephritis, pivmecillinam was most frequently used (43.0%), followed by ciprofloxacin (20.5%) and sulfamethoxazole-trimethoprim (16.3%). For cystitis, the use of pivmecillinam increased the most during the study period (from 46.1 to 56.6%), and for pyelonephritis, the use of sulfamethoxazole-trimethoprim (from 11.4 to 25.5%) followed by ciprofloxacin (from 18.2 to 23.1%). Conclusions During the 10-year study period there was a considerable increase in the proportion of UTI consultations resulting in antibiotic treatment. Cystitis was most often treated with pivmecillinam, and this proportion increased during the study period. Treatment of pyelonephritis was characterized by more use of broader-spectrum antibiotics, use of both sulfamethoxazole-trimethoprim and ciprofloxacin increased during the study period. These trends, indicative of enduring changes in consultation and treatment patterns for UTIs, will have implications for future antibiotic stewardship measures and policy.

Patterns and trends of antibacterial treatment in patients with urinary tract infections, 2015–2019: an analysis of health insurance data

“…The change in prevalence is in contrast to an increase reported from Norway between an earlier period [ 15 ]. Changes in antibiotic prescription with a general decline in antibiotic use for all indications was seen in Germany, mainly due to decreasing prescription rates in children.…”

Identifying women’s preferences for treatment of urinary tract infection: a discrete choice experiment

“…Also, the mean age of the women in our study was comparable with a study that assessed all UTI consultations in Norway over a 10-year period, suggesting that the impact of the recruitment method on age was limited. 15 We restricted the information collection to shorten the time to complete the experiment and to attract more participants. As such, demographic information of our study sample was sparse, which could be considered a limitation as well.…”

“…Also, the mean age of the women in our study was comparable with a study that assessed all UTI consultations in Norway over a 10-year period, suggesting that the impact of the recruitment method on age was limited. 15 …”

Improved management of cystitis in primary care following the implementation of a simple multifaceted intervention

“…On the other hand, the different recommendations related to the first-line drugs for the management of cystitis, depending on the local susceptibility profile, makes it difficult to compare our results with other studies. 28 , 29 In our territory, fosfomycin is widely used for the management of cystitis. Of note in our study was the reduction in the prescription of 2 sachets of fosfomycin in the context of a simple cystitis.…”