Evaluation of antibiotic prescribing for the treatment of male community-acquired urinary tract infections using reimbursement data

Abstract

Introduction: Urinary tract infection (UTI) in men, although less common than in women, present specific diagnostic and therapeutic challenges. This study aims to evaluate the prescribing practices of general practitioners (GPs) for male UTI in France, focusing on adherence to guidelines.

Materials and methods: We used an anonymous reimbursement database of antibiotics prescribed 15 days around an urine culture between September 2019 and August 2022 in a French region. Antibiotic prescriptions for male UTI were analysed according to adherence to national guidelines. Cluster analysis was used to identify different GP prescribing profiles. Prescription duration was assessed according to the number of antibiotic boxes delivered in the community pharmacy.

Results: We included 7,816 urine culture prescriptions from 940 GPs for 6,457 male patients. We estimated compliance with French recommendations to be 55.7% for empirical treatment and 68.1% for documented treatment. GPs were divided into three clusters with different adherence to recommendations of 22%, 44% and 77%. Treatment duration for fluoroquinolones and cotrimoxazole was heterogeneous between GPs, but mainly too short.

Conclusions: Our results suggest that our method could identify GPs who do not prescribe in accordance with recommendations and enable health insurance systems to target educational interventions to improve antibiotic prescribing practices.

Fig 1. Flowchart of exclusion and inclusion of male urinary tract infections from the Doubs French Health Insurance Database.

Fig 2. Percentage of antibiotics prescribed empirically (n = 6,514) or documented (n = 2,072) by general practitioners for the treatment of urinary tract infections in men in the Doubs between 2019 and 2022.

AMX: amoxicillin; AMC: amoxicillin and clavulanic acid; CEF: cefixime; CRO: ceftriaxone; CIP: ciprofloxacin; LVX: levofloxacin; OFL: ofloxacin; TMP/SMX: cotrimoxazole; FOS: fosfomycin; PIV: pivmecillinam; NIT: nitrofurantoin.

Fig 3. Percentage of general practitioner (GP) prescriptions for (A) choice of antibiotic for empirical treatment within cluster 1 (25 GPs), cluster 2 (125 GPs) and cluster 3 (80 GPs), (B) duration in days of empiric-only and documented-only prescriptions for fluoroquinolones and cotrimoxazole within cluster A (103 GPs), cluster B (33 GPs) and cluster C (85 GPs).

The clusters were determined by hierarchical agglomeration clustering using the Ward method. AMX: amoxicillin; AMC: amoxicillin and clavulanic acid; CEF: cefixime; CRO: ceftriaxone; CIP: ciprofloxacin; LVX: levofloxacin; OFL: ofloxacin; TMP/SMX: cotrimoxazole; PIV: pivmecillinam.

Fig 4. Link between empirical prescribing and documented prescribing when the management of a male urinary tract infection benefited from a reassessment of antibiotic therapy (N = 770).

Left: empirical treatment. Right: documented treatment. The lines symbolize the link between empirical and documented treatment for a given case. The percentages (> 2%) indicate the proportion of each treatment prescribed as empiric or documented. AMX: amoxicillin; AMC: amoxicillin and clavulanic acid; CEF: cefixime; CRO: ceftriaxone; FQ: fluoroquinolones; TMP/SMX: cotrimoxazole.

Fig 5. Evaluation of the duration in days of fluoroquinolone or cotrimoxazole empirically prescribed by general practitioners selected from clusters A, B and C.

Treatment reassessed corresponds to empirical treatment with a documented prescription of the same or a different antibiotic.