Taur Ying, Smith Miriam A
Department of Medicine, Division of Infectious Diseases, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA.
Clin Infect Dis. 2007 Mar 15;44(6):769-74. doi: 10.1086/511866. Epub 2007 Feb 1.
Uncomplicated urinary tract infection (UTI) is one of the most common infections encountered and treated in outpatients. A set of guidelines published in 1999 by the Infectious Diseases Society of America recommends trimethaprim-sulfamethoxazole as first-line therapy.
We undertook a study of cross-sectional data describing the use of ambulatory medical services in the United States by women > or = 18 years of age who had uncomplicated UTI. Data from 1996 to 2001 were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to (1) examine the prescribing practices for the treatment of uncomplicated UTI and (2) determine whether these practices were influenced by the recommendation in the Infectious Diseases Society of America guidelines. The major outcomes measurement was to evaluate whether antibacterial selection was influenced by the Infectious Diseases Society of America guidelines. Data were analyzed by year, treatment in private offices vs. hospital clinics, race, geographic location, the specialty of the prescribing health care provider, and the payment method of the patient.
We identified 2339 cases of uncomplicated UTI. Trimethaprim-sulfamethoxazole and ciprofloxacin were the most commonly prescribed drugs. Despite the Infectious Diseases Society of America guidelines, the use of trimethaprim-sulfamethoxazole did not change significantly (odds ratio, 0.89; 95% confidence interval, 0.60-1.30; P = .53), whereas the use of ciprofloxacin increased significantly (odds ratio, 1.75; 95% confidence interval, 1.11-2.75; P < or = .016). Similar results were obtained after adjusting for age, geographic region, race, physician specialty, payment method, and whether the visit was by a new or returning patient.
Despite the Infectious Diseases Society of America recommendation of trimethaprim-sulfamethoxazole as first-line therapy for uncomplicated UTI, physicians in the United States have not altered their prescribing practices. Adjustment for age, geographic region, race, physician specialty, and payment method confirmed a lack of adherence to this recommendation.
单纯性尿路感染（UTI）是门诊中最常见的感染之一，也是门诊治疗的常见疾病。美国传染病学会1999年发布的一套指南推荐甲氧苄啶 - 磺胺甲恶唑作为一线治疗药物。
我们对18岁及以上患有单纯性UTI的美国女性使用门诊医疗服务的横断面数据进行了研究。1996年至2001年的数据来自国家门诊医疗调查和国家医院门诊医疗调查，目的是：（1）检查单纯性UTI的治疗处方做法；（2）确定这些做法是否受到美国传染病学会指南建议的影响。主要结局指标是评估抗菌药物的选择是否受美国传染病学会指南的影响。数据按年份、私人诊所与医院诊所的治疗情况、种族、地理位置、开处方的医疗保健提供者的专业以及患者的支付方式进行分析。
我们确定了2339例单纯性UTI病例。甲氧苄啶 - 磺胺甲恶唑和环丙沙星是最常开具的药物。尽管有美国传染病学会的指南，但甲氧苄啶 - 磺胺甲恶唑的使用并未显著变化（优势比，0.89；95%置信区间，0.60 - 1.30；P = 0.53），而环丙沙星的使用显著增加（优势比，1.75；95%置信区间，1.11 - 2.75；P≤0.016）。在对年龄、地理区域、种族、医生专业、支付方式以及就诊患者是新患者还是复诊患者进行调整后，得到了类似的结果。
尽管美国传染病学会推荐甲氧苄啶 - 磺胺甲恶唑作为单纯性UTI的一线治疗药物，但美国医生并未改变他们的处方做法。对年龄、地理区域、种族、医生专业和支付方式进行调整后，证实了对该建议的不遵守。
