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Please use this identifier to cite or link to this item: http://hdl.handle.net/2262/64044

Title: Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland.
Author: BENNETT, KATHLEEN
Sponsor: Health Research Board
Author's Homepage: http://people.tcd.ie/bennettk
Keywords: Infection
Urinary tract
management
UTI
antimicrobial prescribing
Issue Date: 2011
Publisher: BioMed Central
Citation: Vellinga A, Cormican M, Hanahoe B, Bennett K, Murphy AW, Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland., BMC family practice, 12, 1, 2011, 108
Series/Report no.: BMC family practice;12, 1
Abstract: BACKGROUND: Urinary 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. METHODS: Management 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. RESULTS: A 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. CONCLUSIONS: There appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.
Description: PUBLISHED
URI: http://hdl.handle.net/2262/64044
Related links: http://dx.crossref.org/10.1186%2F1471-2296-12-108
Appears in Collections:Pharmacology & Therapeutics (Scholarly Publications)

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