Treatment of urinary tract infections in Swiss primary care: quality and determinants of antibiotic prescribing

BMC Fam Pract. 2020 Jul 1;21(1):125. doi: 10.1186/s12875-020-01201-1.

Abstract

Background: Urinary tract infections are one of the most common reasons for prescribing antibiotics in primary care. Current guidelines recommend fosfomycin, nitrofurantoin, or trimethoprim - sulfamethoxazol as empiric first line antimicrobial agents in uncomplicated infections. However, there is evidence that the use of fluoroquinolones, which are no longer recommended, is still inappropriate high. We determined antibiotic prescription patterns, quality and factors affecting antibiotic prescriptions in urinary tract infections in primary care in Switzerland.

Methods: From June 2017 to August 2018, we conducted a cross-sectional study in patients suffering from a urinary tract infection (UTI). Patient and general practitioners characteristics as well as antibiotic prescribing patterns were analysed.

Results: Antibiotic prescribing patterns in 1.352 consecutively recruited patients, treated in 163 practices could be analysed. In 950 (84.7%) patients with an uncomplicated UTI the prescriptions were according to current guidelines and therefore rated as appropriate. Fluoroquinolones were prescribed in 13.8% and therefore rated as inappropriate. In multivariable analysis, the age of the general practitioner was associated with increasing odds of prescribing a not guideline recommended antibiotic therapy.

Conclusions: We found a high degree of guideline conform antibiotic prescriptions in patients with an uncomplicated urinary tract infection in primary care in Switzerland. However, there is still a substantial use of fluoroquinolones in empiric therapy.

Keywords: Antibiotic prescribing quality; Primary care; Quality indicator; Switzerland; Urinary tract infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / classification
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence
  • Humans
  • Inappropriate Prescribing* / prevention & control
  • Inappropriate Prescribing* / statistics & numerical data
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'* / standards
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Primary Health Care* / methods
  • Primary Health Care* / standards
  • Primary Health Care* / statistics & numerical data
  • Quality Indicators, Health Care
  • Switzerland / epidemiology
  • Urinary Tract Infections* / diagnosis
  • Urinary Tract Infections* / drug therapy
  • Urinary Tract Infections* / epidemiology

Substances

  • Anti-Bacterial Agents