Antibiotic prescribing for cystitis: how well does it match published guidelines?

Abstract

Purpose: Cystitis is one of the most common bacterial infections seen by physicians in outpatient settings. Published clinical guidelines by the Infectious Disease Society of America and other organizations have been established to enable effective treatment, while attempting to decrease cost and limit antibiotic resistance.

Methods: Insurance claims data for employees and dependents of a single Midwest corporation, with Preferred Provider Organization coverage, diagnosed with cystitis between 1996 and 1999 were matched to prescription drug claims for those who filled an antibiotic prescription within 3 days of diagnosis.

Results: For acute and recurrent cystitis physicians prescribed trimethoprim-sulfamethoxazole 37% and 18% respectively. The other most common antibiotics prescribed were the broad-spectrum flouroquinolones, and nitrofurantoin. The mean duration for these prescriptions was 10 days regardless of whether the infection was acute or recurrent.

Conclusions: The first line recommended antibiotic, trimethoprim-sulfamethoxazole, was prescribed in 37% of acute infections, and for considerably longer than the suggested 3-day course of therapy. Steps should be taken to educate physicians and patients on the choice and dosage of antibiotics for cystitis to minimize emergence of antibiotic resistance.