Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht; Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
Br J Gen Pract. 2023 Feb 23;73(728):e204-e210. doi: 10.3399/BJGP.2022.0354. Print 2023 Mar.
Nitrofurantoin is the first-choice antibiotic treatment for uncomplicated urinary tract infections (UTIs) in males according to the Dutch primary care UTI guideline. However, prostate involvement may be undetected and renders this treatment less suitable.
To compare the nitrofurantoin failure fraction with that found with use of other antibiotics in adult males diagnosed by their GP with an uncomplicated UTI, as well as GP adherence to the Dutch primary care UTI guideline.
Retrospective observational cohort study using routine healthcare data for males seeking care at GP practices participating in the Julius GP Network from 2014 to 2020.
Medical records were screened for signs and symptoms of complicated UTIs, antibiotic prescriptions, and referrals. Treatment failure was defined as prescription of a different antibiotic within 30 days after initiation of antibiotic therapy and/or acute hospital referral. The effects of age and comorbidities on failure were assessed using multivariable logistic regression.
Most UTI episodes in males were uncomplicated ( = 6805/10 055 episodes, 68%). Nitrofurantoin was prescribed in 3788 (56%) of uncomplicated UTIs, followed by ciprofloxacin ( = 1887, 28%), amoxicillin/clavulanic acid ( = 470, 7%), and trimethoprim/sulfamethoxazole ( = 285, 4%). Antibiotic failure occurred in 25% (95% confidence interval [CI] = 23 to 26), 10% (95% CI = 9 to 12), 20% (95% CI = 16 to 24), and 14% (95% CI = 10 to 19) of episodes, respectively. The nitrofurantoin failure fraction increased with age. Comorbidities, adjusted for age, were not associated with nitrofurantoin failure.
Nitrofurantoin failure was common in males with uncomplicated UTI and increased with age.
根据荷兰初级保健尿路感染指南，对于男性单纯性尿路感染（UTI），首选的抗生素治疗药物是呋喃妥因。然而，前列腺感染可能未被检测到，这使得这种治疗方法不太适用。
比较男性单纯性尿路感染患者中，使用呋喃妥因与其他抗生素治疗的失败率，并比较全科医生对荷兰初级保健尿路感染指南的遵循情况。
使用常规医疗保健数据进行回顾性观察队列研究，研究对象为 2014 年至 2020 年期间在 Julius GP 网络参与的全科医生诊所就诊的男性。
对医疗记录进行筛选，以寻找复杂性尿路感染的迹象和症状、抗生素处方和转诊情况。治疗失败定义为在开始抗生素治疗后 30 天内开出不同的抗生素和/或急性医院转诊。使用多变量逻辑回归评估年龄和合并症对失败的影响。
大多数男性尿路感染为单纯性（=10055 例中的 6805 例，68%）。在单纯性 UTI 中，处方呋喃妥因的有 3788 例（56%），其次是环丙沙星（=1887，28%）、阿莫西林/克拉维酸（=470，7%）和复方磺胺甲噁唑（=285，4%）。抗生素治疗失败分别发生在 25%（95%可信区间 [CI] = 23%至 26%）、10%（95% CI = 9%至 12%）、20%（95% CI = 16%至 24%）和 14%（95% CI = 10%至 19%）的患者中。呋喃妥因治疗失败率随年龄增加而增加。调整年龄后，合并症与呋喃妥因治疗失败无关。
男性单纯性尿路感染患者中，呋喃妥因治疗失败较为常见，且随年龄增加而增加。
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