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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 retrosp...

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Autores principales: Wilcox, Mark, Heaton, Dave, Mulgirigama, Aruni, Joshi, Ashish V, Chirikov, Viktor, Gibbons, Daniel C, Webb, David, Marston, Xiaocong L, Alexander, Myriam, Mitrani-Gold, Fanny S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10395449/
http://dx.doi.org/10.1093/jacamr/dlad077.022
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author Wilcox, Mark
Heaton, Dave
Mulgirigama, Aruni
Joshi, Ashish V
Chirikov, Viktor
Gibbons, Daniel C
Webb, David
Marston, Xiaocong L
Alexander, Myriam
Mitrani-Gold, Fanny S
author_facet Wilcox, Mark
Heaton, Dave
Mulgirigama, Aruni
Joshi, Ashish V
Chirikov, Viktor
Gibbons, Daniel C
Webb, David
Marston, Xiaocong L
Alexander, Myriam
Mitrani-Gold, Fanny S
author_sort Wilcox, Mark
collection PubMed
description 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.
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spelling pubmed-103954492023-08-03 P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England Wilcox, Mark Heaton, Dave Mulgirigama, Aruni Joshi, Ashish V Chirikov, Viktor Gibbons, Daniel C Webb, David Marston, Xiaocong L Alexander, Myriam Mitrani-Gold, Fanny S JAC Antimicrob Resist Abstracts 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. Oxford University Press 2023-08-02 /pmc/articles/PMC10395449/ http://dx.doi.org/10.1093/jacamr/dlad077.022 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Wilcox, Mark
Heaton, Dave
Mulgirigama, Aruni
Joshi, Ashish V
Chirikov, Viktor
Gibbons, Daniel C
Webb, David
Marston, Xiaocong L
Alexander, Myriam
Mitrani-Gold, Fanny S
P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England
title P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England
title_full P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England
title_fullStr P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England
title_full_unstemmed P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England
title_short P18 Treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in England
title_sort p18 treatment patterns and extent of inappropriate antimicrobial treatment among female patients with uncomplicated urinary tract infection in england
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10395449/
http://dx.doi.org/10.1093/jacamr/dlad077.022
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