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Overprescribed fluoroquinolones for cystitis increases risk for antibiotic resistance
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SAN DIEGO — Most primary care providers inappropriately prescribed fluoroquinolone antibiotics for acute cystitis, increasing the risk for resistance, according to data presented at ICAAC 2015.
The findings contradict the updated 2010 Infectious Diseases Society of America (IDSA) guidelines, which recommend that providers assign nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX) and fosfomycin as first-line therapies for uncomplicated cystitis, according to Larissa Grigoryan, MD, PhD, from Baylor College of Medicine, and colleagues. The current guidelines urge providers to save fluoroquinolones for more serious infections due to the increasing rate of resistance associated with the agent.
“If we fail to reduce inappropriate antibiotic use, we may lose effective antibiotic treatment in the future,” Grigoryan wrote in an abstract summary.
She and her colleagues used data from the EPIC Clarity database to identify women who were treated for acute cystitis in one of two private family practices between 2011 and 2014. They reviewed 1,546 primary care visits and found that the most common type of antibiotic prescribed was fluoroquinolone (51.6%), followed by nitrofurantoin (33.5%) and TMP-SMX (12%).
Moreover, it was estimated that 75% of all antibiotics were prescribed longer than the recommended duration, which can result in higher costs and increase antibiotic resistance, according to Grigoryan. Excessive durations were reported in 82% of prescriptions for TMP-SMX, 73% for nitrofurantoin and 71% for fluoroquinolone. These data also were published in Open Forum Infectious Diseases.
“Primary care physicians treat a wide spectrum of health problems, and the lack of adherence to the guidelines may be due in part of the difficulty of keeping up with new recommendations for many different diseases,” Grigoryan wrote. “Our results show that we need to develop focused strategies to improve adherence to cystitis guidelines.” – by Stephanie Viguers
Reference:
Grigoryan L, et al. Low Concordance with Treatment Guidelines for Treatment of Acute Cystitis in Primary Care. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-21, 2015; San Diego.
Disclosure: Grigoryan reports no relevant financial disclosures.
*This article was updated on Oct. 29.