Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland

BMC Family Practice

Research Article

Belinda Hanahoe¹  Martin Cormican²  Kathleen Bennett³  Andrew W Murphy⁴  Akke Vellinga⁴ 

[1] Department of Medical Microbiology, University Hospital, Galway, Ireland;Department of Medical Microbiology, University Hospital, Galway, Ireland;Centre for Health from Environment, Ryan Institute, NUI Galway, Ireland;Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, Dublin, Ireland;Discipline of General Practice, School of Medicine, NUI Galway, Ireland;

关键词: management;    UTI;    antimicrobial prescribing;   

DOI  :  10.1186/1471-2296-12-108

 received in 2011-06-01, accepted in 2011-10-03,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundUrinary tract infections (UTIs) are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice.MethodsManagement of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample.ResultsA total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI. An antimicrobial agent was prescribed to 56% (481) of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%), trimethoprim (26%) and fluoroquinolones (17%). Variation between practices in antimicrobial prescribing as well as in their preference for certain antimicrobials, was observed. Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients given an antimicrobial or treatment with ciprofloxacin in all patients. Prescribing cost was lower for nitrofurantoin. Empirical treatment of all patients with trimethoprim only was less effective due to the higher resistance levels.ConclusionsThere appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.

【 授权许可】

CC BY   
© Vellinga et al; licensee BioMed Central Ltd. 2011