Antimicrobial prescribing for urinary tract infection in primary health care

Abstract

Objectives: The objectives of this study were to assess the prescription of antibiotics for urinary tract infection (UTI) in general practice, the degree of agreement with the Directorate General for Health guidelines for treatment of urinary tract infections in the community, to identify the infecting microorganisms, and to determine their susceptibility to antibiotics. Type of study: Cross-sectional study. Location: Family Health Units of Lisbon and Vale do Tejo, Portugal. Population: Patients 18 years of age and older with a clinical and/or laboratory diagnosis of UTI Material and Methods: Thirty-eight family physicians collected data between November 2011 and January 2012. We obtained a non-random sample of 104 episodes of UTI in patients aged 18 years and older. Variables studied were gender, age, type of UTI, request for urine culture, choice of antibiotics based on urine culture results, antibiotic prescriptions, urine culture results and antimicrobial susceptibility. Results: Acute uncomplicated cystitis in non-pregnant women was the most common type of UTI (81,7%). Urine cultures were requested in 72,1% of cases. Antibiotics were prescribed in 93,3% of cases, with fosfomycin (38,1%) and nitrofurantoin (21,6%) the most common antibiotics prescribed. For acute uncomplicated cystitis in non-pregnant women we found that antibiotic prescription was in line with the guideline in 64,2% of cases. The urine culture was positive in 82,1% of cases and E. coli was isolated in 76,1% of these. No bacterial resistance to fosfomycin or nitrofurantoin was reported. Conclusions: In most episodes of UTI an appropriate prescription was chosen consistent with current guidelines. E. coli was the most prevalent microorganism isolated and showed a high susceptibility to fosfomycin and nitrofurantoin.