Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 28;20(7):e0327197.
doi: 10.1371/journal.pone.0327197. eCollection 2025.

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

Adrien Biguenet  1   2 , Céline Slekovec  1   2 , Kévin Bouiller  1   3 , Xavier Bertrand  1   2
Affiliations

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

Adrien Biguenet et al. PLoS One. .

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.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of exclusion and inclusion of male urinary tract infections from the Doubs French Health Insurance Database.
Fig 2
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
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
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
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.
See this image and copyright information in PMC

References

    1. Naylor NR, Atun R, Zhu N, Kulasabanathan K, Silva S, Chatterjee A, et al. Estimating the burden of antimicrobial resistance: a systematic literature review. Antimicrob Resist Infect Control. 2018;7:58. doi: 10.1186/s13756-018-0336-y - DOI - PMC - PubMed
    1. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019;19(1):56–66. doi: 10.1016/S1473-3099(18)30605-4 - DOI - PMC - PubMed
    1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–55. doi: 10.1016/S0140-6736(21)02724-0 - DOI - PMC - PubMed
    1. European Centre for Disease Prevention and Control. Antimicrobial consumption in the EU/EEA (ESAC-Net) - Annual Epidemiological Report for 2022; 2023. [cited 2024 Jul 30]. Available from: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobi...
    1. Agence Nationale de sécurité du médicament et des produits de santé. La consommation des antibiotiques en France de 2000 à 2020; 2023. [cited 2024 Jul 30] Available from: https://ansm.sante.fr/actualites/lansm-publie-un-rapport-sur-la-consomma...

MeSH terms

Substances