Reconsultation and Antimicrobial Treatment of Urinary Tract Infection in Male and Female Patients in General Practice

Conference:

SAPC ASM 2016 - Dublin

Talk Code:

P2.18

Presenter:

Akke Vellinga

Co-authors:

Sinead Duane, Martin Cormican, Andrew W Murphy, Akke Vellinga

Author institutions:

Discipline of General Practice, National University of Ireland, Galway

Problem

Current antimicrobial prescribing guidelines indicate that male and female patients with urinary tract infection (UTI) should be treated using the same antimicrobials but for different duration. This study aims to explore differences in antimicrobial prescribing and reconsultations for UTI in daily clinical practice for males and females.

Approach

All prescribing data over a fifteen month period was obtained from the 30 practices participating in Supporting the Improvement and Management of Prescribing for urinary tract infection (SIMPle) study. A total of 2557 adult patients with suspected UTI were included in the analysis. Re-consultation, antimicrobial prescribing and culture test results were analysed to identify differences between males and females.

Findings

An antimicrobial was prescribed significantly more often to females (77%) than males (63%). Nitrofurantoin was prescribed more often in females (58% vs 41%) but males received a fluoroquinolone more often (11% vs 3%). A urine sample was obtained during 1256 or 50% of the consultations and this was similar in males and females. Fewer male urine samples showed a positive culture compared to female urine samples (36% vs 54%). Reconsultation was 1.4 times higher in females and if the antimicrobial prescribed was not the recommended firstline (nitrofurantoin), reconsultation after empirical prescribing was significantly higher. However, when a urine culture is obtained, a positive culture is the most important predictor of reconsultation (1.8 (95% CI 1.3-2.5)).

Consequences

After considering the difference in prescribing (firstline, non firstline and not prescribing), the occurrence of reconsultation is same for male and female UTI patients. This suggests, when prescribing empirically, male and female UTI patients should be treated equally with first line antimicrobials (nitrofurantoin) with different durations. However, considering the culture test before prescribing antimicrobials may improve outcomes.

Submitted by:

Meera Tandan

Funding acknowledgement:

Sincere thanks to Supporting the Improvement and Management of Prescribing for urinary tract infection (SIMPle) study team and Health Research Board of Ireland for providing opportunity to write paper.