Improving antibiotic prescription in urinary tract infections

Guido Schmiemann, Kathrin Jobski, Falk Hoffmann, Axel Hamprecht, Jutta Bleidorn, Gagyor Ildikó, Greser Alexandra, Heintze Christoph

Keywords: antibiotic stewardship; health services research; resistance rates

Introduction:

Urinary tract infections are among the most common reason for encounter and subsequent antibiotic prescriptions. Due to the risk of collateral damage and increasing resistance rates, explicit recommendations against the use of fluoroquinolones in uncomplicated urinary tract infections have been issued. It is unclear, a) to what extent these recommendations were followed and b) what is the optimal method to reduce a high share of fluorquinolone prescriptions.

Method:

Prescription data from a local statutory health insurance (SHI) company were used to describe antibiotic prescription rates for urinary tract infections between 2015 – 2019 in Bremen, Germany.
A multimodal intervention (information on guideline recommendations, regular feedback on prescription rates including benchmarking and provision of regional resistance rates) was tested in a RCT in 128 practices in four regions in Germany.

Results:

According to routine data fluoroquinolones were most often prescribed (26.3%), followed by fosfomycin (16.1%). During the study period, shares of fluoroquinolones decreased from 29.4% to 8.7% in females and from 45.9% to 22.3% in males.
A multimodal intervention resulted in a significant decrease in second line antibiotics

Conclusions:

While routine data showed a clear trend toward a more guideline adherent prescription pattern, there is still room for improvement regarding the use of second-line antibiotics especially fluoroquinolones. Individual feedback and provision of regional resistance data seem to be effective in reducing the amount of second line antibiotics.
doi: 10.1186/s12875-022-01816-6 ; DOI: 10.1186/s12879-021-06660-0

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