Two Times Versus Four Times Daily Cephalexin Dosing for the Treatment of Uncomplicated Urinary Tract Infections in Females

Yetsko, Aidan; Draper, Heather M; Eid, Kristen; Jameson, Andrew P; Dumkow, Lisa E

doi:10.1093/ofid/ofad430

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…20 Notably, UTI guidelines are pending a new update and there has been subsequent literature to support use of cephalexin for uncomplicated UTI. [20][21][22][23] Dissemination of updated evidence and implementation into practice is often delayed. 24,25 This study had limitations.…”

Section: Discussionmentioning

confidence: 99%

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications

Oertli,

Staub,

Zhang

et al. 2024

Infect. Control Hosp. Epidemiol.

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Objective: We sought to evaluate whether implementing mandatory indications for outpatient electronic antibiotic orders or using encounter International Classification of Diseases, Tenth Revision (ICD10) codes more accurately reflected clinicians’ charted diagnosis in encounter notes. Secondarily, we examined the appropriateness of antibiotic prescriptions. Design: Cross-sectional study. Methods: Mandatory indications were added to all outpatient electronic antibiotic orders on May 18, 2022. A randomly selected convenience sample of 1300 outpatient encounters with antibiotics from walk-in clinics was reviewed. Adjusted logistic regression was used to compare the congruence between encounter ICD10 code and charted diagnosis for encounters from July 15 to September 15, 2021 (pre-implementation period) to the congruence between encounter ICD10 code, charted diagnosis, and mandatory indication for encounters from July 15 to September 15, 2022 (post-implementation period). Antibiotic appropriateness based on charted diagnosis was also evaluated. Results: Among 1300 outpatient encounters, congruence between charted diagnosis and ICD10 code significantly increased in the post-implementation period (87.7% (565/644)) versus pre-implementation (83.3% (540/648), adjusted odds ratio (aOR) 1.52; 95% CI 1.03–2.25). Congruence between charted diagnosis and mandatory indication during post-implementation was 95.2% (613/644) and >5 times more likely to be congruent than charted diagnosis and ICD10 code during pre-implementation (aOR 5.45; 95% CI 3.26–9.11). Antibiotic prescribing based on charted diagnosis was twice as likely to be appropriate in the post-implementation period (aOR1.99; 95% CI 1.32–2.98). Conclusions: Mandatory indications within antibiotic orders show better congruence with charted diagnosis than ICD10 codes and may increase antibiotic appropriateness and congruence between ICD10 code and charted diagnosis.

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Section: Discussionmentioning

confidence: 99%

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications

Oertli,

Staub,

Zhang

et al. 2024

Infect. Control Hosp. Epidemiol.

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Evaluation of Local Prescribing Patterns and Antimicrobial Resistance in Women With Acute Pyelonephritis Caused by E. coli

Seales,

Welch,

Seifert

2024

Ann Pharmacother

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Background: Owing to increasing local Escherichia coli resistance and current guidelines for the treatment of acute pyelonephritis (APN) over 14 years old, an evaluation of local prescribing patterns is warranted. Objective: The purpose of this study was to evaluate local prescribing patterns and appropriateness of antibiotics in acute uncomplicated APN. Methods: This is a retrospective cohort study of female patients aged 18 to 89 years diagnosed with APN and positive urine culture growing E. coli. Exclusion criteria included pregnancy, immunocompromised status, and complicated urinary tract infections. Outcomes included antibiotic appropriateness and its effects on hospital admission, hospital length of stay, and 30-day readmission. Results: Between 2017 and 2022, 308 female patients were diagnosed with APN and had positive urine cultures, with 104 seen only in the emergency department (ED) and 109 admitted to the hospital. Patients seen in the ED had a significant increase in E. coli resistance to discharge antibiotics (12.5% vs 2.8%, P = 0.0070). In those patients discharged on antibiotics resistant to E. coli, significantly more patients returned to the ED in 30 days (31.3% vs 10.7%, P = 0.0155). Conclusion and Relevance: Patients seen only in the ED were more likely to have resistant organisms to discharge antibiotics compared with those admitted to the hospital. Patients discharged on antibiotics resistant to E. coli had a 3-fold increase in returning to the ED within 30 days regardless of admitted location. Follow-up of all cultures should be performed, and patients resistant to discharge antibiotics should be contacted and antibiotic regimens changed.

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Gaps in primary care management of urinary tract infections in Singapore

Liew,

Wong,

Chong

et al. 2024

Ann Acad Med Singap

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Urinary tract infection (UTI) is a common presentation in primary care, but gaps of care have not been well established in Singapore. UTIs are one of the most common bacterial infections worldwide,1 constituting around 1% of all ambulatory clinic visits.2 The healthcare burden of UTIs remains highly significant, with billions per year lost in societal costs (e.g. healthcare costs and time missed from work) alone.2 In Singapore, genitourinary infections were the second most common group of conditions for which antibiotics were prescribed in 2021.3

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Two Times Versus Four Times Daily Cephalexin Dosing for the Treatment of Uncomplicated Urinary Tract Infections in Females

Cited by 3 publications

References 15 publications

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications

Impact of mandatory indications for outpatient antibiotic orders on accurate tracking of antibiotic indications

Evaluation of Local Prescribing Patterns and Antimicrobial Resistance in Women With Acute Pyelonephritis Caused by E. coli

Gaps in primary care management of urinary tract infections in Singapore

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