Ruyer O, Slekovec C, Bertrand X, Faller J-P, Hoen B, Talon D, Leroy J
Service de maladies infectieuses et réanimation, centre hospitalier de Belfort-Montbéliard, Belfort-Montbéliard, France.
Med Mal Infect. 2010 Jun;40(6):352-7. doi: 10.1016/j.medmal.2010.01.006. Epub 2010 Feb 20.
We assessed the impact of a committed guideline at the end of the first quarter 2008 on the management of urinary tract infection (UTI) with antibiotic prescription (fluoroquinolone, fosfomycin, and nitrofurantoin), by analysing reimbursement data for ambulatory care provided by the regional health insurance agency.
During the survey, we observed a 13.2% decrease of norfloxacin prescriptions between the first quarter 2008 and the first quarter 2009. The (fosfomycin+nitrofurantoin)/norfloxacin ratio increased between the third quarter 2007 and the first quarter 2009 from 0.55 to 0.72 and from 0.82 to 1.13 for general practitioners and hospital physicians respectively. The global number of patients treated with these antibiotics remained stable during the period. The number of fluoroquinolone prescription was stable between the first quarter 2008 and the first quarter 2009 with 28,427 DDD and 28,363 DDD, respectively; while the number of single dose rise in the same time from 151 DDD to 427.5 DDD, respectively.
The three messages which seem to be essential for an optimal use of fluoroquinolones in UTIs are: no treatment for bacterial colonisation (asymptomatic bacteriuria) except for specific cases, no indication for fluoroquinolones in non-complicated acute cystitis and for elderly women, UTI is complicated only if it occurs in women with co-morbidities regardless of age.
Our indicators suggest that our guideline had an impact on the prescription of fluoroquinolones for uncomplicated acute cystitis.
我们通过分析地区健康保险机构提供的门诊护理报销数据，评估了2008年第一季度末一项专门指南对尿路感染（UTI）抗生素处方（氟喹诺酮类、磷霉素和呋喃妥因）管理的影响。
在调查期间，我们观察到2008年第一季度至2009年第一季度诺氟沙星处方量下降了13.2%。2007年第三季度至2009年第一季度，全科医生和医院医生的（磷霉素+呋喃妥因）/诺氟沙星比率分别从0.55增至0.72以及从0.82增至1.13。在此期间，接受这些抗生素治疗的患者总数保持稳定。2008年第一季度至2009年第一季度，氟喹诺酮类的处方量保持稳定，分别为28427限定日剂量（DDD）和28363 DDD；而同期单剂量的数量分别从151 DDD增至427.5 DDD。
在UTIs中优化使用氟喹诺酮类药物似乎至关重要的三条信息是：除特定情况外，不治疗细菌定植（无症状菌尿）；非复杂性急性膀胱炎和老年女性无氟喹诺酮类药物使用指征；无论年龄如何，UTI仅在合并症女性中发生时才属于复杂性。
我们的指标表明，我们的指南对非复杂性急性膀胱炎的氟喹诺酮类药物处方产生了影响。
