Increased adherence to treatment guidelines in patients with urinary tract infection in primary care: A retrospective study

BACKGROUND: Urinary tract infection (UTI) is common in primary care and leads to a high number of antibiotic prescriptions. Antimicrobial resistance is a global health problem; better antimicrobial prescribing is one way to limit antimicrobial resistance. We aimed to describe the number of consultations for patients diagnosed with lower urinary tract infection (LUTI) and pyelonephritis and changes in prescribing of antibiotics to men and women with LUTI and pyelonephritis in Swedish PHC between the years 2008 and 2013. METHODS: We performed a descriptive study of changes in UTI diagnosis and antibiotic prescribing in UTI for the years 2008, 2010 and 2013. The Primary Care Record of Infections in Sweden, a database regarding diagnosis linked antibiotic prescribing in primary care, was analyzed concerning data for men and women of all ages regarding UTI visits and antibiotic prescribing. The results were analyzed in relation to current national guidelines. RESULTS: There was a variability in consultation incidence for LUTI with an increase between 2008 and 2010 and a decrease between 2010 and 2013, resulting in a slight rise in consultation incidence between 2008 and 2013. The use of recommended nitrofurantoin or pivmecillinam in LUTI in women increased from 54% in 2008 to 69% in 2013. Fluoroquinolones or trimethoprim were prescribed in 24% of LUTI cases in women in 2008 and in 7% of cases in 2013. Prescriptions of pivmecillinam or nitrofurantoin in male LUTI cases increased from 13% in 2008 to 31% in 2013. Fluoroquinolones or trimethoprim were prescribed in 54% of male LUTI cases in 2008 and 32% in 2013. CONCLUSIONS: Swedish GPs seem to follow national guidelines in the treatment of LUTI in women. In male LUTI cases, the prescriptions of fluoroquinolones remain high and further research is needed to follow prescription patterns and enhance more prudent prescribing to this group of patients.