Concordance of Outpatient Antibiotic Prescribing with Infectious Diseases Society of America (IDSA) Guidelines for the Treatment of Acute Uncomplicated Cystitis in Southern Maine

BACKGROUND: Our study aims to assess prescribing concordance with the 2010 Infectious Diseases Society of America (IDSA) guidelines for the treatment of acute uncomplicated cystitis (AUC). Additionally, this study aims to assess potential explanations for prescriber discordance. METHODS: This is an IRB-approved retrospective analysis of female patients ≥ 18 years of age at four family medicine clinics over a one year period. Patients with one of the following International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes were screened for entry: acute cystitis (N30.0), unspecified cystitis (N30.9), or urinary tract infection (N39.0). Exclusion criteria are pregnancy, urinary abnormalities, recurrent UTI, active sexually transmitted infections, active malignancies, documented allergies to all first-line antibiotics, prophylactic antibiotic use, temperature >100.4° F, flank pain, chronic kidney disease, and diagnosis of pyelonephritis. To meet concordance, all three components must be met: selection of a recommended drug, correct dose, and suggested duration. A survey was distributed to 37 providers to assess guideline knowledge and prescribing preferences for the treatment of AUC. Descriptive statistics and regression analyses were performed. RESULTS: Overall antibiotic prescribing concordance with IDSA guidelines was 58.8% of 165 analyzed visits. Nitrofurantoin (51%) was the most common antibiotic prescribed, followed by sulfamethoxazole–trimethoprim (SMX-TMP) (33%), ciprofloxacin (13%), and amoxicillin (3%). No patient was prescribed fosfomycin. Longer durations than recommended were often prescribed for nitrofurantoin (25%), SMX-TMP (25.5%), and ciprofloxacin (33%). Survey response rate was 24 out of 37 providers (64.9%). Six out of 24 responses (25%) identified fluoroquinolones as last line therapy for the treatment of AUC. CONCLUSION: We report suboptimal prescribing concordance rate with the IDSA guidelines for the treatment of AUC. The treatment of AUC in our family medicine setting is an area of opportunity to implement antimicrobial stewardship interventions. In addition to providing prescribing guidance, emphasis on education regarding recommendations including drug, dose, and duration may be important to sustain high concordance prescribing rates. DISCLOSURES: All authors: No reported disclosures.