Saatchi Ariana, Silverman Michael, Shariff Salimah Z, Patrick David M, Morris Andrew M, Reid Jennifer N, Povitz Marcus, McCormack James, Lalji Fawziah Marra
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Faculty of Medicine, University of Western Ontario, London, Ontario, Canada.
J Assoc Med Microbiol Infect Dis Can. 2024 Jun 3;9(2):61-72. doi: 10.3138/jammi-2023-0031. eCollection 2024 Jun.
Urinary tract infections (UTI) are responsible for a significant portion of female, outpatient antibiotic prescriptions. Especially true in uncomplicated cases, where symptoms remain the cornerstone of diagnosis, ensuring the optimal choice of agent, dose, and duration may mitigate future bacterial resistance and lower the likelihood of adverse events and/or recurrence. This study is the first in Canada to examine the quality of antibiotic prescribing to females in the outpatient setting, for uncomplicated UTI-by agent, dose, and duration.
All adult female residents of British Columbia with a physician record for cystitis from January 1, 2014, to December 31, 2018, were identified. Patients with a history of urologic abnormalities, spinal cord injury, catheter use, kidney transplant, as well as pregnant females, were excluded. Primary outcomes included the proportion of total episodes prescribed and the proportion of appropriate antibiotic use, examined using Poisson regression.
A total of 182,162 episodes of cystitis were examined, with 70% receiving an antibiotic prescription. The rate of cystitis-associated prescribing was 697 prescriptions per 1,000 population. Overall, 35% of prescriptions were appropriate by guideline adherence or clinical justification. Nitrofurantoin and trimethoprim-sulfamethoxazole, accounted for 71% of total antibiotic use. Seven days was the most commonly dispensed duration of therapy, followed by 5, then 10.
Shortening length of therapy in line with clinical guidelines and encouraging the use of first line agents present clear, actionable targets for provincial stewardship efforts.
尿路感染（UTI）占女性门诊抗生素处方的很大一部分。在非复杂性病例中尤其如此，症状仍是诊断的基石，确保药物、剂量和疗程的最佳选择可减轻未来的细菌耐药性，并降低不良事件和/或复发的可能性。本研究是加拿大首次在门诊环境中，按药物、剂量和疗程，检查针对女性非复杂性UTI的抗生素处方质量。
确定了2014年1月1日至2018年12月31日期间在不列颠哥伦比亚省有膀胱炎医生记录的所有成年女性居民。排除有泌尿系统异常、脊髓损伤、使用导管、肾移植病史的患者以及孕妇。主要结局包括处方总发作次数的比例和适当使用抗生素的比例，采用泊松回归进行分析。
共检查了182,162例膀胱炎发作，其中70%接受了抗生素处方。膀胱炎相关处方率为每1000人697张处方。总体而言，35%的处方符合指南或有临床依据。呋喃妥因和甲氧苄啶-磺胺甲恶唑占抗生素总使用量的71%。7天是最常用的治疗疗程，其次是5天，然后是10天。
根据临床指南缩短治疗疗程，并鼓励使用一线药物，为省级管理工作提供了明确、可操作的目标。
