Patterns and trends of antibacterial treatment in patients with urinary tract infections, 2015-2019: an analysis of health insurance data

Abstract

Background: Urinary tract infections are among the most common reason for encounter and subsequent antibiotic prescriptions. Due to the risk of collateral damage and increasing resistance rates, explicit recommendations against the use of fluoroquinolones like ciprofloxacin in uncomplicated urinary tract infections have been issued. However, to what extent these recommendations were followed and if there are relevant differences between the disciplines involved (general practitioners, urologists, paediatricians and gynaecologists) are unknown.

Methods: We used anonymized data from a local statutory health insurance (SHI) company, which covered about 38% of all SHI-insured persons in the federal state of Bremen, Germany between 2015-2019. Data included demographics, outpatient diagnoses and filled prescriptions on an individual level.

Results: One-year prevalence of urinary tract infections was 5.8% in 2015 (females: 9.2%, males: 2.5%). Of all 102,715 UTI cases, 78.6% referred to females and 21.4% to males, 6.0% of cases were younger than 18 years. In females, general practitioners were the most common diagnosing speciality (52.2%), followed by urologists (20.0%) and gynaecologists (16.1%). Overall, fluoroquinolones were most often prescribed (26.3%), followed by fosfomycin (16.1%) and the combination of sulfamethoxazole and trimethoprim (14.2%). Fluoroquinolones were most often prescribed by urologists and general practitioners, while gynaecologists preferred fosfomycin. During the study period, shares of fluoroquinolones decreased from 29.4% to 8.7% in females and from 45.9% to 22.3% in males.

Conclusions: Despite a clear trend toward a more guideline adherent prescription pattern, there is still room for improvement regarding the use of second-line antibiotics especially fluoroquinolones. The choice of antibiotics prescribed differs between specialities with higher uptake of guideline-recommended antibiotics by gynaecologists, mainly because of higher prescription shares of fosfomycin.

Keywords: Guideline adherence; Health services research; Prescription pattern; Primary care; Urology.

Fig. 1

Shares of antibacterials prescribed in the quarter of a UTI diagnosis from 2015 to 2019 by sex and age group. (N = 102,006 prescriptions)

Fig. 2

Trend: shares of antibacterials prescribed in the quarter of a UTI diagnosis by sex. (N = 102,006 prescriptions)

Fig. 3

Trend: shares of antibacterials prescribed by GP, urologist, gynaecologist and paediatrician in the quarter of a UTI diagnosis. (N = 95,648 prescriptions)

Fig. 4

Trend: shares of antibacterials prescribed by GP and urologist in the quarter of a UTI diagnosis by sex. (N = 79,665 prescriptions)