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Open Access Highly Accessed Research article

Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland

Akke Vellinga1*, Martin Cormican23, Belinda Hanahoe2, Kathleen Bennett4 and Andrew W Murphy1

Author Affiliations

1 Discipline of General Practice, School of Medicine, NUI Galway, Ireland

2 Department of Medical Microbiology, University Hospital, Galway, Ireland

3 Centre for Health from Environment, Ryan Institute, NUI Galway, Ireland

4 Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, Dublin, Ireland

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BMC Family Practice 2011, 12:108  doi:10.1186/1471-2296-12-108

Published: 3 October 2011

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.

Keywords:
management; UTI; antimicrobial prescribing