Room for Improvement in Treatment of Acute Cystitis - European Medical Journal

Room for Improvement in Treatment of Acute Cystitis

2 Mins

ACCORDING to a new study, unchallenging urinary tract infection (UTI) is generally treated suitably as per the guidelines in most females; however, there are opportunities for improvement. The study, carried out by Jacqueline Y. Kikuchi and colleagues from Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, followed the Infectious Diseases Society of America (IDSA) guidelines for females who were premenopausal.

The study population included 46,793 females within the USA Military Health System, aged 18 to 50 years, with unchallenging acute cystitis. About 91% were treated according to the IDSA guidelines for females who are premenopausal. The patients not included in the study included females with pyelonephritis, renal insufficiency, urinary tract abnormalities, urologic procedures, diabetes, organ transplant, HIV, immunosuppression, or pregnancy. The IDSA recommends a first-line therapy in this population, treatment with nitrofurantoin monohydrate or macrocrystals, trimethoprim with sulfamethoxazole, fosfomycin trometamol, or pivmecillinam; however, the use of fluoroquinolone antibiotics is discouraged.

Prescribing guideline-concordant treatment odds were notably 60% lower in urologists when compared to obstetricians and gynaecologists (OB/GYN). Additionally, when compared to OB/GYNs, internal medicine specialists, family physicians, surgeons, and emergency medicine specialists had higher IDSA concordance rates. Clinicians had overprescribed the treatment in 5.9% of patients. The findings in unacclimated analyses demonstrated that overprescribing was more likely in emergency medicine and family medicine specialities, compared to urology and OB/GYN specialities. To conclude, the results found that OB/GYNs and urologists had a remarkably higher probability of concordant treatment in comparison to other specialities.

The study limitations included the lack of analytical information on dosage duration of antibiotic therapy, or urine culture results. Additionally, investigators were unable to establish which patients received inappropriate antibiotic therapy for asymptomatic bacteriuria instead of uncomplicated cystitis. “Lower rates of IDSA guideline concordance were seen in obstetrics and gynaecology and urology, which could potentially benefit from targeted antibiotic stewardship programs and policies that promote greater adherence to IDSA guidelines,” Kikuchi’s team stated.

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