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Fluoroquinolones most frequently prescribed antibiotic for uncomplicated UTI in women
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Fluoroquinolones were the most frequently prescribed antibiotic treatment for uncomplicated urinary tract infections in women aged 18 years and older from 2002 to 2011, according to recent study results.
“[National Ambulatory Medical Care Survey (NAMCS)] data from 1989-1998 showed that fluoroquinolone prescribing surpassed trimethoprim-sulfamethoxazole for uncomplicated UTI in women,” Miwako Kobayashi, MD, MPH, epidemic intelligence service officer in the CDC’s Division of Bacterial Sciences, and colleagues wrote. “Therefore, fluoroquinolones have remained the most frequently prescribed antibiotic class for uncomplicated UTI in U.S. outpatients. At the same time, a decrease in sulfonamide prescribing and an increase in nitrofurantoin prescribing was observed.”
The researchers aimed to describe current antibiotic prescribing practices for uncomplicated UTI to help ongoing stewardship efforts and optimize antibiotic use, and to identify factors associated with fluoroquinolone prescribing for uncomplicated UTI. Using NAMCS and National Hospital Ambulatory Medical Care Survey datasets from 2002 to 2011, they identified 7,111 outpatient visits for women aged 18 years and older diagnosed with uncomplicated UTI.
Kobayashi and colleagues found that 80% (95% CI, 77-82) of visits resulted in an antibiotic prescription and that fluoroquinolones were prescribed most commonly (49%), followed by sulfonamides (27%) and nitrofurantoin (19%). The proportion of visits associated with fluoroquinolone prescribing did not change significantly during the study period, while the proportion associated with sulfonamides decreased from 35% in 2002-2003 to 23% in 2010-2011 (P = .02), and the proportion associated with nitrofurantoin increased from 14% to 24% during the same time frame (P < .01).
The types of patients most likely to be prescribed fluoroquinolones included those aged 70 years and older (adjusted OR = 2.5; 95% CI, 1.6-3.8) and patients treated by internists rather than family practitioners (aOR = 2; 95% CI, 1.1-3.3). Patients from the West were less likely to be prescribed fluoroquinolones (aOR = 0.6; 95% CI, 0.4-1) than those in the Northeast.
Kobayashi and colleagues noted that increased use of fluoroquinolones for UTI has coincided with increased incidence of fluoroquinolone resistance among uropathogens. In addition, fluoroquinolone use has been associated with subsequent Clostridium difficile infection.
“Additional studies are needed to determine the most effective drivers to optimize prescribing for UTI in ambulatory care settings,” the researchers concluded. “Providers and practices should consider assessing antibiotic selection for UTI as a potential target for antibiotic stewardship implementation.” – by Sarah Kennedy
Disclosure: The researchers report no relevant financial disclosures.
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