Across the United States, in both rural and urban settings, most women with private health insurance receive inappropriate treatment for their urinary tract infections (UTIs), according to a new study.
Of the 670,450 women enrolled in this study, all of whom were diagnosed with uncomplicated UTIs between the ages of 18 and 44, nearly half received the wrong antibiotics and more than three-quarters were prescribed the drug too long. (A UTI is declared ‘uncomplicated’ if the patient has no abnormality or disease that could cause them to have more frequent infections.)
The results are largely consistent from place to place, although patients in more rural areas are likely to prescribe longer antibiotics.
In the course of the study, from 2011 to 2015, there was only a slight improvement in the right prescriptions for antibiotics based on current clinical guidelines.
“Inappropriate antibiotic prescriptions for uncomplicated urinary tract infections are common and have serious consequences at the patient and societal level,” said epidemiologist Anne Mobley Butler of the Washington University School of Medicine, St. Louis.
“Our findings from the study highlight the need for antimicrobial stewardship interventions to improve the prescribing of antibiotics for outpatients, especially in rural areas.”
The research was funded in part by several pharmaceutical companies, including Sanofi Pasteur, Pfizer and Merck. The results were peer-reviewed and largely consistent with the findings of previous studies, suggesting that up to 60 percent of the antibiotics prescribed in intensive care units are ‘unnecessary, inappropriate, or suboptimal’.
It’s not just a problem in the US either. All over the world, UTIs are one of the most common infections leading to emergency visits. In the UK, it is the second most common reason for prescribing antibiotics.
Taking the wrong antibiotics not only has worse results for the individual patient, but longer prescriptions are not necessarily better and can cause bacteria to become resistant, making recurrence more likely and future infections more difficult to treat.
Today, it is estimated that one in three uncomplicated UTIs in women is resistant to the popular combination antibiotics Bactrim (sulfamethoxazole and trimethoprim), and one in five is resistant to five other common antibiotics.
An estimate of the number of deaths associated with antibiotic-resistant UTIs is difficult to determine due to a lack of research and monitoring, but some studies suggest that in US hospitals alone it could be around 13,000 lives per year. And some people suffer from recurrent, resistant infections with little to no relief for years on end.
In the light of these emerging concerns, the Infectious Diseases Society of America (IDSA) and the European Society for Microbiology and Infectious Diseases updated their clinical practice guidelines in 2010. Based on the results of various studies, they now recommend several first-class antibiotics and continue to treat UTIs best, while minimizing the risk of antibiotic resistance.
However, it is clear that doctors and healthcare professionals cannot get the advice. Many people still prescribe antibiotics that are improperly expensive.
Finding out where the most inappropriate prescriptions are can help us target areas where we need to improve adherence to antibiotic guidelines. In the US, rural areas are experiencing numerous health disparities compared to more urban areas, and yet this is the first large-scale study to evaluate how it affects UTI treatment.
The authors are not sure why longer antibiotic treatments for UTIs occur especially in rural areas, but suggest that it has to do with access to care and medicine. In rural areas, women may be given longer prescriptions to avoid future travel if treatment fails.
Studies also show that doctors in the late career are more prevalent in rural areas and more likely to prescribe antibiotics for longer, possibly because they have not yet heard of updated guidelines.
“Accumulating evidence suggests that patients have better outcomes if we change prescriptions from broad-spectrum to narrow-spectrum antibiotics and from longer to shorter duration,” Butler explains.
“Promoting optimal antimicrobial use benefits the patient and society through avoidable side effects, microbiome disruption and antibiotic-resistant infections.”
When up to 60 percent of women may suffer from a UTI at some point in their lives, it is of utmost importance that the guidelines for treatment be better applied, especially as antibiotic resistance increases.
This particular study was based solely on commercially insured individuals, meaning that those who are not insured or who receive public insurance were not considered. Rural areas were also loosely defined, including small towns as well as ‘suburbs’ on the edge of urban areas, and men, who also suffer from UTIs (albeit at a lower rate), were not included.
Future research should focus on filling these gaps, but in the meantime, the trend reinforces the idea that clinicians need to regularly review clinical practice guidelines, even for general conditions they have been treating for years.
“In recent years, little effective progress has been made in reducing inappropriate antibiotic prescriptions for uncomplicated UTIs,” the new article concludes.
“Given the large number of inappropriate prescriptions annually in the United States, as well as the negative consequences at the patient and societal level of unnecessary exposure to antibiotics, antimicrobial stewardship interventions are needed to improve the prescribing of antibiotic UTI antibiotic prescriptions, in particular. in the countryside. “
The study was published in Infection control and hospital epidemiology.