Prescribing pattern of antibiotics and guideline adherence in acute community-acquired uncomplicated urinary tract infections in Pakistani women

Abstract

Aim: Acute urinary tract infection is one of the most predominant community-acquired infections. These infections are often treated with antibiotics, but its inappropriate usage leads to Clostridium difficile infections, resistance development and higher cost. To evaluate the prescribing pattern of antibiotic and adherence to Infectious Diseases Society of America (IDSA) guidelines in uncomplicated urinary tract infections (cystitis and pyelonephritis) among females.

Material and Method: A retrospective, chart-review study was conducted in a teaching hospital in Pakistan. Consecutively two hundred (n=200; cystitis: n=100, pyelonephritis: n=100) medical charts of female patients kept for the last 1 year (May 2018 to April 2019) were enrolled through random systematic sampling technique for comparison purpose. Important information was extracted from medical charts and compared with IDSA recommendations. Finally, collected data were entered into SPSS, version 22.0 for statistical analysis, such as; frequency, percentage and chi-square test. A p-value < 0.05 was considered statistically significant.

Results: The most frequently prescribed antibiotic was ciprofloxacin (58, 29%), followed by nitrofurantoin (39, 19.5%) and ceftriaxone (32, 16%). About, 86 (43%) patients received an appropriate antibiotic. The dose was given according to the guidelines in 84.5% of patients, whereas the duration of prescribed antibiotic was appropriate in 61% of the patients, with a significant inappropriate dose and duration in pyelonephritis patients. A total of 58 patients were completely correct in all steps (drug, dose and duration). The appropriate prescribing of antibiotic with respect to selection/choice, dose and duration were more in cystitis as compared to pyelonephritis.

Conclusions: A low adherence rate with guidelines was observed. Identifying barriers to guideline adherence and urgent steps for the improved prescribing practices in uncomplicated urinary tract infections are required.

Keywords

• infection,women,antibiotic,Pakistan,guidelines

References

1. Reference1: Kabbara WK, Meski MM, Ramadan WH, Maaliki DS, Salameh P. Adherence to International Guidelines for the Treatment of Uncomplicated Urinary Tract Infections in Lebanon. Canadian Journal of Infectious Diseases and Medical Microbiology. 2018;2018. Reference2: Hecker MT, Fox CJ, Son AH, et al. Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting. PloS one. 2014;9(2):e87899. Reference3: Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. The American journal of medicine. 2002;113(1):5-13. Reference4: Hagen TL, Hertz MA, Uhrin GB, Dalager-Pedersen M, Schønheyder HC, Nielsen H. Adherence to local antimicrobial guidelines for initial treatment of community-acquired infections. Dan Med J. 2017;64(6):A5381. Reference5: Parwati I, Kusumandari R, Simões E. Evaluation of extended spectrum beta lactamase (ESBL) producing microorganisms in a tertiary teaching hospital in Bandung, Indonesia. International Journal of Infectious Diseases. 2012;16:e236.Reference6: Shiva F, Ghanaie R, Shirvani F, et al. Pattern of Antibiotic Usage in Children Hospitalized for Common Infectious Diseases. Archives of Pediatric Infectious Diseases. 2018;6(1).Reference7: Khan Z, Ahmed N, Rehman AU, Khan FU, Rahman H. Utilization of Antibiotic Prophylaxis in Three Common Abdominal Surgeries, Adherence to Standard Guidelines and Surgeons' Perception in Teaching Hospitals, Islamabad, Pakistan. MDPI preprint 2019; 2019060119. doi: 10.20944/preprints201906.0119.v1.Reference8: van der Velden L, Tromp M, Bleeker-Rovers C, et al. Non-adherence to antimicrobial treatment guidelines results in more broad-spectrum but not more appropriate therapy. European journal of clinical microbiology & infectious diseases. 2012;31(7):1561-8.Reference9: Liu Y-N. Importance of standardized treatment on community-acquired infection. Community Acquired Infection. 2014;1(1):4.Reference10: McCabe C, Kirchner C, Zhang H, Daley J, Fisman DN. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Archives of internal medicine. 2009;169(16):1525-31.Reference11: Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical infectious diseases. 2011;52(5):e103-e20.Reference12: Grigoryan L, Zoorob R, Wang H, Trautner BW, editors. Low concordance with guidelines for treatment of acute cystitis in primary care. Open forum infectious diseases; 2015: Oxford University Press.Reference13: Kim M, Lloyd A, Condren M, Miller M. Beyond antibiotic selection: concordance with the IDSA guidelines for uncomplicated urinary tract infections. Infection. 2015;43(1):89-94.Reference14: Kahan N, Chinitz D, Waitman D, Kahan E. Empiric treatment of uncomplicated UTI in women: wasting money when more is not better. Journal of clinical pharmacy and therapeutics. 2004;29(5):437-41.Reference15: Grover ML, Bracamonte JD, Kanodia AK, et al., editors. Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. Mayo Clinic Proceedings; 2007: Elsevier.Reference16: Llor C, Rabanaque G, López A, Cots JM. The adherence of GPs to guidelines for the diagnosis and treatment of lower urinary tract infections in women is poor. Family practice. 2010;28(3):294-9.Reference17: Lutters M, Vogt‐Ferrier NB. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database of Systematic Reviews. 2008(3).Reference18: McIsaac WJ, Moineddin R, Ross S. Validation of a decision aid to assist physicians in reducing unnecessary antibiotic drug use for acute cystitis. Archives of internal medicine. 2007;167(20):2201-6