El Khoury Joe, Saleh Nadine, Lahoud Nathalie, Maison Patrick, Hleyhel Mira
Department of Family Medicine, Saint Joseph University, Beirut, Lebanon
INSPECT-LB, Beirut, Lebanon.
BMJ Open Qual. 2024 Dec 23;13(4):e003027. doi: 10.1136/bmjoq-2024-003027.
Urinary tract infections (UTIs) are among the most common bacterial infections, and appropriate antimicrobial therapy with agents that minimise resistance is crucial. Despite international concern, adherence to guidelines is still suboptimal. This study aims to determine the effect of the absence of national guidelines and the rate of conformity to international guidelines among physicians in antibiotic (ATB) prescriptions for the treatment of UTIs in adults and detect the factors that are associated with a higher rate of non-compliance.
Patient-related characteristics and the prescribed ATBs were gathered from patients' medical files, and a questionnaire was directed to physicians to elicit the factors involved in decision-making. Four criteria were evaluated: molecule conformity, daily dose conformity, duration conformity and global conformity.
37 Lebanese physicians and 185 prescriptions were included. The most prevalent class of ATBs was fluoroquinolones (30.3%). Global conformity to guidelines was 31.4%, while conformity on drug choice, daily dose and duration of treatment was 83.2%, 74.7% and 41.6%, respectively. There were no differences in conformity rates according to the physician's specialty (p=0.135). Physicians who studied in an American-system university had an increased risk of non-conformity (adjusted OR (aOR=2.107, p=0.018). Patients with higher education levels, or presenting with fever or chills, were more likely to get a non-compliant prescription (aOR=2.140, p=0.032 and aOR=4.947, p=0.033, respectively).
In a country with no local guidelines, non-conformity to international guidelines is high. Larger national studies are needed with immediate interventions to enhance physicians' prescribing practices. After local guidelines were established, it would be interesting to compare the rate of adherence to these guidelines.
尿路感染（UTIs）是最常见的细菌感染之一，使用能将耐药性降至最低的药物进行适当的抗菌治疗至关重要。尽管受到国际关注，但指南的依从性仍不理想。本研究旨在确定缺乏国家指南对成人尿路感染抗生素（ATB）处方中医师遵循国际指南的影响，并检测与较高不依从率相关的因素。
从患者病历中收集患者相关特征和所开的ATB，并向医生发放问卷以引出决策过程中涉及的因素。评估了四个标准：药物分子符合度、每日剂量符合度、疗程符合度和总体符合度。
纳入了37名黎巴嫩医生和185份处方。最常用的ATB类别是氟喹诺酮类（30.3%）。指南总体符合率为31.4%，而药物选择、每日剂量和治疗疗程的符合率分别为83.2%、74.7%和41.6%。根据医生专业不同，符合率无差异（p = 0.135）。在美国体系大学学习的医生不依从风险增加（调整后比值比（aOR）= 2.107，p = 0.018）。受过高等教育、或有发热或寒战症状的患者更有可能收到不依从的处方（分别为aOR = 2.140，p = 0.032和aOR = 4.947，p = 0.033）。
在一个没有本地指南的国家，不遵循国际指南的情况很严重。需要开展更大规模的全国性研究并立即进行干预，以改善医生的处方行为。在制定本地指南后，比较对这些指南的依从率将很有意义。
