UTIs Improperly Handled Everywhere | MedPage today

Most women with uncomplicated urinary tract infections (UTIs) received inappropriate antibiotics or follow-up treatment longer than the recommended time, a study of nearly 700,000 cases showed.

Overall, 46.7% of patients received prescriptions for inappropriate antibiotics and 76.1% had an inappropriate treatment time. The frequency of inappropriate antibiotic agents was similar between urban and rural patients, but women in rural areas were significantly more likely to continue antibiotic treatment beyond the recommended treatment time.

“Given the high number of inappropriate prescriptions each year in the United States, as well as the negative patient and social effects of inadvertent exposure to antibiotics, interventions are needed. non-chemical stewardship to improve antibiotic prescribing of UTI patients, especially in rural settings, ”wrote Anne M. Butler, PhD, of Washington University in St. Louis. Louis, and co-authors in their online study in Hospital infectious & epilepsy control.

“Existing recommendations for promoting outpatient antibiotic stewardship include establishing a personal commitment and policy for change, reporting on progress, and promoting education around best practice. Future research is needed to identify, disseminate and implement concomitant antibiotic prescribing in rural settings, “the team said.

The main takeaway from the study centers on antibiotic stewardship is not the apparent urban-rural variant, said Brian R. Stork, MD, of the University of Michigan School of Medicine and Western Urology in Muskegon.

“Clinicians and patients need to do a better job of working together to follow evidence-based antibiotic prescribing practices,” said Stork, a spokesman for the American Urological Association. MedPage today. “Whether we are urban or country doctors, we all need to think carefully about our prescribing patterns and be more aware of antibiotic stewardship. “

Changes in urban-rural practices are often more pronounced than have been shown in academic studies, he continued. In rural areas, most UTIs are handled by primary care providers. Patients may need to travel long distances to see a urologist or infectious disease specialist, but such specialists are available in urban areas.

In addition, rural providers may not have ready access to laboratory tests, including urinalysis, and different types of providers may follow different recommendations for the treatment of UTIs.

Rural medicine also has sexual differences in the approach to clinical practice, as opposed to medical practice in urban settings.

“My concern about the study is that people look at it and think that rural doctors are not doing a good job,” Stork said. “People need to understand that the practice of rural medicine is different. For example, if I had a patient with urinary tract disease during the corn harvest season, I might treat that patient with a longer course of antibiotics and keep that patient in the field, harvesting the crop. , feeding the family, rather than erring on the side of taking over and making a big impact on the patient’s well-being. “

The genesis of the study recognized that inappropriate antibiotic use is associated with an increased risk for treatment failure, adverse events, and antibiotic resistance, as well as increased costs, Butler and co-authors noted. Uncomplicated UTIs in women make up about 10.5 million cruise visits each year in the U.S. and are one of the most common reasons for antibiotic use by patients with healthy women.

The American Infectious Diseases Association (IDSA) and the European Society for Microbiology and Infectious Diseases (ESMID) have recommended first-line and long-term antibiotic agents for UTI. However, most prescriptions for UTIs for antibiotics are non-recommended and treatment times.

Several recent studies have documented changes in urban-rural practices in respiratory tracts and pediatric diseases, but no major study evaluated urban-rural changes in outpatient antibiotic prescribing for UTIs, Butler and co-authors.

For the study, they examined urban-rural differences in the risk of inappropriate antibiotic use by an agent and duration for uncomplicated UTIs in women. Data for the study came from a health insurance and medication database.

The researchers defined urban areas as those included in typical metropolitan statistical areas and rural areas like all others. Appropriate antibiotics and treatment time were determined from IDSA-ESMID recommendations.

The analysis included 670,450 women treated for uncomplicated UTI in 2010-2015. Urban areas accounted for 86.2% of the study population. Rural and urban patients had a median age of 30. Rural patients were more likely to live in the south and northwest, and their diseases were more likely to be diagnosed by GPs, pediatricians, no nonphysicians.

Consistent with previous studies, the data showed that nearly half of the patients were receiving inappropriate antibiotics, and three-quarters of treatment followed longer than the recommended time. The frequency of inappropriate antibiotic prescriptions was similar between urban (46.9%) and rural (45.9%) patients and did not vary significantly from one drug or drug class to another.

The rate of inappropriate prescribing fell over the study period from 48.5% in mid-2011 to 43.7% by mid-2015. The rate decreased among urban (48.8% to 43.5%) and rural (46.6% to 44.8%) patients. . With multivariate analysis, rural patients had a slightly lower likelihood of receiving inappropriate representatives (RR 0.98, 95% CI 0.98–0.99) compared with urban patients.

The frequency of inappropriate treatment time also decreased, from 78.3% in mid-2011 to 73.4% in mid-2015. The rate of decline was higher among urban patients (77.1% to 72.0%) compared with rural patients (85.1% at 83.2%). A multivariate study showed that rural patients were 10% more likely to be treated for an inappropriate period of time (95% CI 1.10–1.10).