Journal article
An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections
Open forum infectious diseases, Vol.5(9), pp.ofy198-ofy198
09/01/2018
DOI: 10.1093/ofid/ofy198
PMCID: PMC6121225
PMID: 30191156
Abstract
Abstract Background In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices. Methods We performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration. Results We identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with >75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers. Conclusions Inappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.
Details
- Title: Subtitle
- An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections
- Creators
- Michael J Durkin - Division of Infectious Diseases, Department of Internal MedicineMatthew Keller - Division of Infectious Diseases, Department of Internal MedicineAnne M Butler - Division of Infectious Diseases, Department of Internal Medicine, Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MissouriJennie H Kwon - Division of Infectious Diseases, Department of Internal MedicineErik R Dubberke - Division of Infectious Diseases, Department of Internal MedicineAaron C Miller - Department of Epidemiology, College of Public HealthPhillip M Polgreen - Department of Epidemiology, College of Public Health, Department of Internal Medicine, University of Iowa, Iowa City, IowaMargaret A Olsen - Division of Infectious Diseases, Department of Internal Medicine, Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
- Resource Type
- Journal article
- Publication Details
- Open forum infectious diseases, Vol.5(9), pp.ofy198-ofy198
- DOI
- 10.1093/ofid/ofy198
- PMID
- 30191156
- PMCID
- PMC6121225
- NLM abbreviation
- Open Forum Infect Dis
- ISSN
- 2328-8957
- eISSN
- 2328-8957
- Publisher
- Oxford University Press
- Grant note
- DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences; DOI: 10.13039/100000002, name: National Institutes of Health, award: KL2TR002346, UL1 TR002345; DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: R24 HS19455; DOI: 10.13039/100000054, name: National Cancer Institute, award: R24 HS19455
- Language
- English
- Date published
- 09/01/2018
- Academic Unit
- Infectious Diseases; Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984094370002771
Metrics
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