Research Unit for General Practice, NORCE Norwegian Research Centre, Postboks 22 Nygårdstangen, 5838, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
BMC Fam Pract. 2021 Jun 24;22(1):127. doi: 10.1186/s12875-021-01470-4.
Extensive use of antibiotics and the resulting emergence of antimicrobial resistance is a major health concern globally. In Norway, 82% of antibiotics is prescribed in primary care and one in four prescriptions are issued for the treatment of urinary tract infections (UTI). The aim of this study was to investigate time trends in antibiotic treatment following a consultation for UTI in primary care.
For the period 2006-2015 we linked data from the Norwegian Registry for Control and Payment of Health Reimbursements on all patient consultations for cystitis and pyelonephritis in general practice and out-of-hours (OOH) services, and data from the Norwegian Prescription Database on all dispensed prescriptions of antibiotics.
Altogether 2,426,643 consultations by attendance for UTI took place in the study period, of these 94.5% for cystitis and 5.5% for pyelonephritis. Of all UTI consultations, 79.4% were conducted in general practice and 20.6% in OOH services. From 2006 to 2015, annual numbers of cystitis and pyelonephritis consultations increased by 33.9 and 14.0%, respectively. The proportion of UTI consultations resulting in an antibiotic prescription increased from 36.6 to 65.7% for cystitis, and from 35.3 to 50.7% for pyelonephritis. These observed changes occurred gradually over the years. Cystitis was mainly treated with pivmecillinam (53.9%), followed by trimethoprim (20.8%). For pyelonephritis, pivmecillinam was most frequently used (43.0%), followed by ciprofloxacin (20.5%) and sulfamethoxazole-trimethoprim (16.3%). For cystitis, the use of pivmecillinam increased the most during the study period (from 46.1 to 56.6%), and for pyelonephritis, the use of sulfamethoxazole-trimethoprim (from 11.4 to 25.5%) followed by ciprofloxacin (from 18.2 to 23.1%).
During the 10-year study period there was a considerable increase in the proportion of UTI consultations resulting in antibiotic treatment. Cystitis was most often treated with pivmecillinam, and this proportion increased during the study period. Treatment of pyelonephritis was characterized by more use of broader-spectrum antibiotics, use of both sulfamethoxazole-trimethoprim and ciprofloxacin increased during the study period. These trends, indicative of enduring changes in consultation and treatment patterns for UTIs, will have implications for future antibiotic stewardship measures and policy.
抗生素的广泛使用以及由此产生的抗菌药物耐药性是全球主要的健康问题。在挪威，82%的抗生素用于初级保健，四分之一的处方用于治疗尿路感染 (UTI)。本研究旨在调查初级保健中因 UTI 就诊后的抗生素治疗时间趋势。
在 2006 年至 2015 年期间，我们将挪威控制和支付健康报销登记处的所有膀胱炎和肾盂肾炎普通诊所和非工作时间 (OOH) 服务患者咨询的数据，以及挪威处方数据库中所有开具的抗生素处方的数据进行了链接。
在研究期间，共有 2426643 次 UTI 就诊，其中 94.5%为膀胱炎，5.5%为肾盂肾炎。所有 UTI 咨询中，79.4%在普通诊所进行，20.6%在 OOH 服务进行。从 2006 年到 2015 年，膀胱炎和肾盂肾炎的年就诊次数分别增加了 33.9%和 14.0%。膀胱炎和肾盂肾炎的 UTI 就诊导致抗生素处方的比例分别从 36.6%增加到 65.7%和从 35.3%增加到 50.7%。这些观察到的变化在过去几年中逐渐发生。膀胱炎主要用匹美西林（53.9%）治疗，其次是甲氧苄啶（20.8%）。肾盂肾炎最常使用匹美西林（43.0%），其次是环丙沙星（20.5%）和磺胺甲噁唑-甲氧苄啶（16.3%）。在研究期间，膀胱炎中匹美西林的使用量增加最多（从 46.1%增加到 56.6%），而肾盂肾炎中磺胺甲噁唑-甲氧苄啶（从 11.4%增加到 25.5%）和环丙沙星（从 18.2%增加到 23.1%）。
在 10 年的研究期间，因 UTI 就诊后接受抗生素治疗的比例有了相当大的增加。膀胱炎最常使用匹美西林，并且在研究期间该比例有所增加。肾盂肾炎的治疗特点是使用更广泛的抗生素，磺胺甲噁唑-甲氧苄啶和环丙沙星的使用量都在研究期间有所增加。这些表明咨询和治疗 UTI 模式持续变化的趋势将对未来的抗生素管理措施和政策产生影响。
