Compliance to international guidelines and rational use of antibiotics in urinary tract infections in a country without national guidance: a cross-sectional study.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.