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

Abstract

Background Urinary tract infections are among the most common reason for encounter and subsequent antibiotic prescriptions. Due to the risk of collateral damage and increasing resistance rates, explicit recommendations against the use of fluoroquinolones like ciprofloxacin in uncomplicated urinary tract infections have been issued. However, to what extent these recommendations were followed and if there are relevant differences between the disciplines involved (general practitioners, urologists, paediatricians and gynaecologists) are unknown. Methods We used anonymized data from a local statutory health insurance (SHI) company, which covered about 38% of all SHI-insured persons in the federal state of Bremen, Germany between 2015—2019. Data included demographics, outpatient diagnoses and filled prescriptions on an individual level. Results One-year prevalence of urinary tract infections was 5.8% in 2015 (females: 9.2%, males: 2.5%). Of all 102,715 UTI cases, 78.6% referred to females and 21.4% to males, 6.0% of cases were younger than 18 years. In females, general practitioners were the most common diagnosing speciality (52.2%), followed by urologists (20.0%) and gynaecologists (16.1%). Overall, fluoroquinolones were most often prescribed (26.3%), followed by fosfomycin (16.1%) and the combination of sulfamethoxazole and trimethoprim (14.2%). Fluoroquinolones were most often prescribed by urologists and general practitioners, while gynaecologists preferred fosfomycin. During the study period, shares of fluoroquinolones decreased from 29.4% to 8.7% in females and from 45.9% to 22.3% in males. Conclusions Despite a clear trend toward a more guideline adherent prescription pattern, there is still room for improvement regarding the use of second-line antibiotics especially fluoroquinolones. The choice of antibiotics prescribed differs between specialities with higher uptake of guideline-recommended antibiotics by gynaecologists, mainly because of higher prescription shares of fosfomycin.

Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador

“…In our study, general practitioners were responsible for a slightly greater number of UTI diagnoses compared to specialist physicians. This is consistent with a study conducted in Germany in outpatients during 2015–2019 [ 45 ], where UTI diagnoses and drug prescriptions were almost equal among these types of professionals. This could be explained by similarities between the health systems of the two countries; in Ecuador, the second level of health care may still include general practitioners.…”

“…coli to ciprofloxacin in community-acquired UTI in the female population aged 15 to 60 years [ 62 ]. Our data indicate that ciprofloxacin was the most common antimicrobial agent prescribed in all cases of UTIs, which is similar to other studies [ 31 , 45 , 59 , 60 ]. The factors influencing the choice of antibiotics by practitioners were not evaluated and are beyond the scope of our research.…”

“…Antibiotic usage in UTI cases displays significant variation; according to existing literature, the most frequently utilized antibiotics include ciprofloxacin (17%–36.4%), TMP-SMX (14.2%–26.3%), nitrofurantoin (20.4%–35.9%), fosfomycin (0.2%–16.1%), and cephalosporins (4.8%–20.1%) [ 31 , 45 , 59 , 60 ]. This variation in antibiotic use can be attributed to the presence and adherence to local and international guidelines, individual prescriber preferences, patient-specific factors, and the local availability of antibiotics [ 61 ].…”

Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial

“…Overall, the prescription proportions for second line antibiotics at the beginning of the study were lower than we had assumed based on routinely collected data from 2012 to 2013 7. More recent data for prescribing frequencies in Germany has documented a marked decline in the prescription of fluoroquinolones decreasing from 29.4% to 8.7% between 2015 and 2019 25. One explanation might be that the covid-19 pandemic reduced attention to a more restricted use of fluorquinolones as recommended by the European Medical Agency,26 thus enhancing the effect of the intervention.…”

“…7 More recent data for prescribing frequencies in Germany has documented a marked decline in the prescription of fluoroquinolones decreasing from 29.4% to 8.7% between 2015 and 2019. 25 One explanation might be that the covid-19 pandemic reduced attention to a more restricted use of fluorquinolones as recommended by the European Medical Agency, 26 thus enhancing the effect of the intervention. Our results also appear relevant more broadly in Europe, where quinolone prescription rates vary from 3% in Sweden to 22% in Belgium.…”