Outpatient prescribing and prophylactic antibiotic use for recurrent urinary tract infections in British Columbia, Canada

Abstract

Introduction: Urinary tract infections (UTI) are one of the most common infections, have frequent recurrences, and may debilitate quality of life. UTI is considered recurrent if there are three individual cases of UTI within 12 months. The objective of this study was to set a baseline for recurrent urinary tract infections (rUTI) in women, and rUTI-associated antibiotic prescribing in the presence of antimicrobial stewardship efforts.
 Methods: Data for rUTI in women were organized through a provincial prescription database, physician billing system, and a consolidation file to combine antibiotic prescribing, diagnoses and patient demographics. Rates of rUTI cases and prescriptions were examined, and trends of antibiotics were separated by major anatomical therapeutic chemical classes.
 Results: A total of 2 234 903 rUTI-associated prescriptions were dispensed for 674 785 rUTI cases from 2008–2018; 2 205 703 prescriptions were for treatment and 29 310 prescriptions were for prophylaxis of rUTI. The prevalence of rUTI cases declined by 59%, while overall rUTI-associated antibiotic prescribing decreased by 73%. The greatest decrease was seen in quinolones (87%), while nitrofurantoin became the most common rUTI-antibiotic dispensed, accounting for 42% of prescriptions overall.
 Conclusions: Implementation of numerous antimicrobial stewardship efforts may have contributed to the decrease in antibiotic prescribing, particularly for quinolones. In line with local antibiograms and guidelines, nitrofurantoin is the most used antibiotic for rUTI by far, distinctly preferred over other antibiotics secondary to the lack of E. coli resistance.

Young Women’s Attitudes and Behaviors in Treatment and Prevention of UTIs: Are Biomedical Students at an Advantage?

“…The authors attribute this to an increased awareness of interstitial cystitis or bladder pain syndrome, which can present similarly to recurrent UTI but does not require treatment with antibiotics. A lower rate of dispensation of prophylactic antibiotics has been observed as well [26]. Furthermore, findings from recent research have suggested that a considerable proportion of women are willing to tolerate less than optimal management in certain respects in order to avoid antimicrobial treatment for UTIs.…”

Recurrent urinary tract infection: Rates and prescription patterns in the antibiotic stewardship era

“…Data for rUTI in adult women were collected from a provincial database, a physician billing system, and a consolidation file to combine antibiotic prescribing, diagnoses, and patient demographics. 2 During the study period, the prevalence of rUTI cases declined by a whopping 59%, with the steepest decline occurring in women aged 19-49 years (65%), and to a lesser degree, in women 80 years or older (45%). Although not measured in this study, it is unlikely that established risk factors for rUTI (such as frequency of sexual intercourse, genitourinary syndrome of menopause, cystocele, and urinary incontinence) decreased during the study period.…”

Antibiotic stewardship in the era of precision medicine

“…Thus, antibiotic stewardship has a crucial role to play in reducing overtreatment of bacteriuria. Saatchi et al 31 investigated the rates of recurrent UTI cases and prescriptions in the presence of antimicrobial stewardship efforts in British Colombia between 2008 and 2018. During the course of the study, UTI guidelines and community-based antimicrobial stewardship programmes were incorporated into evidence-based practice to help physicians prescribe antibiotics appropriately.…”