Impact of a region wide antimicrobial stewardship guideline on urinary tract infection prescription patterns

Int J Clin Pharm. 2012 Apr;34(2):325-9. doi: 10.1007/s11096-012-9606-6. Epub 2012 Jan 18.


Background: Fluoroquinolones are frequently prescribed for non complicated urinary tract infection treatments and have a negative ecological impact. We aimed to substitute them by antibiotics with narrower activity spectrum in order to preserve fluoroquinolone activity in complicated hospital infections.

Objective: To assess the impact of a multi-modal approach that combines the dispatching of antibiotic prescription guidelines and voluntary attendance at educational sessions on general practitioners' (GP) antibiotic prescription habits.

Setting: This study was led in Franche-Comté, a French eastern region, where GPs were given a guideline recommending a restricted use of fluoroquinolones for urinary tract infections.

Method: Segmented regression analysis of interrupted time series was used to assess changes in antibiotic prescription.

Main outcome measure: The antibiotic prescription data of nitrofurantoin, fosfomycin-trometamol and fluoroquinolones for women aged 15-65 years were obtained from the regional agency of health insurance.

Results: Twenty months after intervention, the number of nitrofurantoin and fosfomycintrometamol prescriptions increased by 36.8% (95% CI: 30.6-42.2) and 28.5% (95% CI: 22.9-35.4), respectively, while that of norfloxacin decreased by 9.1% (95% CI: -15.3 to -3.5).

Conclusion: This study suggests that the dispatch of the guideline on urinary tract infection had a moderate impact on antibiotic prescriptions.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Infective Agents / therapeutic use*
  • Attitude of Health Personnel
  • Drug Prescriptions / standards
  • Drug Utilization / standards
  • Education, Medical, Continuing
  • Female
  • Fosfomycin / therapeutic use
  • France
  • General Practitioners / education
  • General Practitioners / standards*
  • Guideline Adherence
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Middle Aged
  • Nitrofurantoin / therapeutic use
  • Norfloxacin / therapeutic use
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards*
  • Program Evaluation
  • Regression Analysis
  • Time Factors
  • Urinary Tract Infections / drug therapy*
  • Young Adult


  • Anti-Infective Agents
  • Fosfomycin
  • Nitrofurantoin
  • Norfloxacin