Determinants of quinolone versus trimethoprim-sulfamethoxazole use for outpatient urinary tract infection

Abstract

Quinolones are increasingly favored over trimethoprim-sulfamethoxazole (TMP-SMX) for empirical treatment of uncomplicated urinary tract infection (UTI). This is associated with increasing resistance toward this broad-spectrum group of antibiotics. Our objective is to describe the prescribing patterns and identify determinants of the choice between TMP-SMX and quinolones for outpatient UTI treatment in Switzerland. An ongoing national Sentinel surveillance system was used to study 11,799 antibiotic prescriptions for UTI in adult outpatients and associated physician and patient factors between 2006 and 2008, to compare the prescription of quinolones versus that of TMP-SMX for treatment of UTI. Most UTI episodes were diagnosed as cystitis (90%). TMP-SMX was prescribed for one-fifth (22%) of UTIs. Independent predictors for prescribing quinolones were pyelonephritis and physicians with low thresholds for prescribing antibiotics for upper respiratory tract infections ("high prescribers"), whereas female patients were more likely to receive TMP-SMX. High-prescribing physicians also more often cared for patients who themselves favor antibiotic treatment (P < 0.001). Quinolones are commonly prescribed to outpatients with UTI. Nonclinical factors influence the choice of quinolones versus TMP-SMX, which may provide opportunities for interventions to improve prescribing patterns and control quinolone resistance.

Fig 1

Frequency (%) of antibiotic treatment in outpatients presenting with influenza-like illness by physician. Data on influenza-like illness visits are from the Sentinel Surveillance Network System between 2006 and 2008. Prescriptions of 150 physicians described by their prescribing rate in influenza are displayed. The cutoff point for classification of physicians' prescribing rates is indicated by the vertical line. A rate of ≤16% stands for a low prescriber, and a rate of >16% indicates a high prescriber.