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dc.contributor.authorVellinga, Akke
dc.contributor.authorCormican, Martin
dc.contributor.authorHanahoe, Belinda
dc.contributor.authorMurphy, Andrew W.
dc.date.accessioned2012-04-20T16:50:54Z
dc.date.available2012-04-20T16:50:54Z
dc.date.issued2011
dc.identifier.citationVellinga, A.,Cormican, M.,Hanahoe, B.,Bennett, K.,Murphy, A. W. (2011) 'Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland'. BMC Fam Pract, 12 (11).en_US
dc.identifier.issn1471-2296 (Electronic) 14
dc.identifier.urihttp://www.ncbi.nlm.nih.gov/pubmed/21967276http://www.ncbi.nlm.nih.gov/pubmed/21967276
dc.identifier.urihttp://hdl.handle.net/10379/2681
dc.description.abstractABSTRACT: BACKGROUND: Urinary tract infections (UTIs) are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice. METHODS: Management of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample. RESULTS: A total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI. An antimicrobial agent was prescribed to 56% (481) of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%), trimethoprim (26%) and fluoroquinolones (17%). Variation between practices in antimicrobial prescribing as well as in their preference for certain antimicrobials, was observed. Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients given an antimicrobial or treatment with ciprofloxacin in all patients. Prescribing cost was lower for nitrofurantoin. Empirical treatment of all patients with trimethoprim only was less effective due to the higher resistance levels. CONCLUSIONS: There appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.ABSTRACT: BACKGROUND: Urinary tract infections (UTIs) are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice. METHODS: Management of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample. RESULTS: A total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI. An antimicrobial agent was prescribed to 56% (481) of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%), trimethoprim (26%) and fluoroquinolones (17%). Variation between practices in antimicrobial prescribing as well as in their preference for certain antimicrobials, was observed. Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients given an antimicrobial or treatment with ciprofloxacin in all patients. Prescribing cost was lower for nitrofurantoin. Empirical treatment of all patients with trimethoprim only was less effective due to the higher resistance levels. CONCLUSIONS: There appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.en_US
dc.description.sponsorshipHRBen_US
dc.formatapplication/pdfen_US
dc.language.isoenen_US
dc.relation.ispartofBMC Fam Practen
dc.subjectManagementen_US
dc.subjectUTIen_US
dc.subjectAntimicrobial prescribingen_US
dc.titleAntimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Irelanden_US
dc.typeArticleen_US
dc.date.updated2012-04-20T16:41:00Z
dc.local.publishedsourcehttp://www.biomedcentral.com/1471-2296/12/108en_US
dc.description.peer-reviewedpeer-reviewed
dc.contributor.funder|~|
dc.internal.rssid1283574
dc.local.contactAkke Vellinga, General Practice/Bacteriology, Nui Galway. 5192 Email: akke.vellinga@nuigalway.ie
dc.local.copyrightcheckedYes
dc.local.versionACCEPTED
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