P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England

BACKGROUND AND OBJECTIVES: Inappropriate antimicrobial treatment of uncomplicated urinary tract infection (uUTI) has potential impacts on healthcare resource use and costs. We characterized treatment patterns for uUTI in England, including the extent of inappropriate treatment. METHODS: This retrospective cohort study utilized anonymized patient data from the Clinical Practice Research Datalink (CPRD) database from 1 January 2018 to 31 December 2019. Female patients ≥12 years with a diagnosis of community-acquired uUTI (index), who had received ≥1 oral antibiotic within ±5 days of index and had ≥14 months of CPRD data linked to English Hospital Episode Statistics data, were included. Patients who attended an accident and emergency department for urologic reasons, were hospitalized 28 days pre-index, or had complicated UTI or complicating comorbidities were excluded. uUTI episodes were defined as the 28-days post-index and follow-up data was captured through 29 February 2020, for a potential episode extension due to re-prescription. Treatment appropriateness for index uUTI in terms of drug class, duration and dose, was defined per NICE UTI guidelines (Figure 1). [Figure: see text] RESULTS: Overall, 120519 female uUTI patients were evaluated. First-line therapy among 118540 female patients ≥16 years of age included nitrofurantoin (71%), trimethoprim (14.5%), amoxicillin (4%), pivmecillinam (2.7%) and fluoroquinolone (1.6%), with evident variation in treatment by age and line of therapy (Table 1). Inappropriate treatment, i.e. per above definition, was given to 52460 (43.5%) patients, and was less common among patients with re-prescription (35%) than without re-prescription (44%). Patients requiring a re-prescription were older, more often menopausal, had greater comorbid burden, and had higher prevalence of previous recurrent uUTI or prior exposure to antimicrobials (Table 2). Few regional or practice-level differences were observed (Table 2). [Table: see text] [Table: see text] CONCLUSIONS: Inappropriate treatment, based on drug class, duration and dose, was common among patients with uUTI, and inappropriate treatment was higher among patients without re-prescription versus those with re-prescription. Patient-level differences, rather than regional- or practice-level differences, appear to drive inappropriate antibiotic use. The effect of inappropriate treatment on disease progression risk will be assessed in future work.