[Use of antibiotics in primary care: treatment of urinary infection].

OBJECTIVES

To analyse the primary care therapeutic approach to urinary tract infections (UTI), and, a secondary objective, to obtain information on the microbiological profile and resistance to antibiotics in this field, with the aim of making therapeutic recommendations.

DESIGN

The UTI diagnosed through systematic checking of sediment and/or culture, requests from health centres are described.

SETTING

9 Health Centres in Palma (Mallorca) during November 1992.

PATIENTS AND OTHER PARTICIPANTS

Out of 2,484 requests for sediment and/or uroculture, clinical history was found in 2,033. At the end there were 232 patients whose request for analysis was for suspected UTI, among whom there were 43 recurring cases, which meant a total of 275 cases.

MEASUREMENTS AND MAIN RESULTS

The most frequent germ was Escherichia coli. 68% had complicated UTI. Empirical treatment was carried out in 60.7%. Treatment of the first episode of UTI was with quinolones in 73.3% of cases, with norfloxacine in 44.1%. There was a higher percentage of resistance of Escherichia coli to cotrimoxazole (49.0%), ampicilline-sulbactam (46.4%), ampicilline (42.0%) and cephalexin (31.4%). In 50 cases there was therapeutic failure, due (among the most commonly used drugs) to norfloxacine in 12.4%, to cotrimoxazole in 28.6%, to norfloxacine in 27.3% and to pipemidic in 18.9%.

CONCLUSIONS

There are many more specific than empirical treatments as well as excessive use of drugs not recommended as first choice in primary care. The level of resistance to the new quinolones is considerable and is greater still for some antimicrobial drugs used for UTI.