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Published on: June 23, 2015
General practitioners do not systematically adhere to regional recommendations on treatment of uncomplicated urinary
Thea Christoffersen1, Lars Bjerrum, Anni Brit Sternhagen Nielsen
1Section and Research Unit of General Practice, Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark. theachristoffersen@gmail.com.
Introduction:
Uncomplicated urinary tract infection (uUTI) is a common reason for seeing a GP. In Denmark, it is debated if sulfamethizole or pivmecillinam should be recommended for empirical treatment of uUTIs. We evaluated sulfamethizole and pivmecillinam use in the five Danish regions from 2007 to 2011 and explored if the choice of antibiotic in primary care was in accordance with the regional recommendations for uUTI.
Material And Methods:
Regional drug use data on pivmecillinam and sulfamethizole from 2007 to 2011 were retrieved from the Registry of Medicinal Product Statistics. Regional recommendations from the same period were identified. We calculated differences in consumption based on defined daily doses per 1,000 inhabitants per day (DID) of pivmecillinam and sulfamethizole between the five regions, and intraregional developments.
Results:
Four regions had recommendations on uUTI in 2011. From 2007 to 2009, sulfamethizole was the only antibiotic recommended. Pivmecillinam was recommended along with sulfametizole in one of four regions from 2010, which increased to two regions in 2011. During the five-year period, sulfamethizole consumption decreased in all regions. The absolute decrease ranged from 0.4 to 0.6 DID. Pivmecillinam consumption increased steadily; the absolute increase ranged from 1.5 to 2.5 DID. During the whole period, the total pivmecillinam consumption was higher than the total sulfamethizole consumption.
Conclusion:
Pivmecillinam dominated the treatment of uUTIs, whereas sulfamethizole prevailed in the regional recommendations, which suggests a lack of adherence to regional recommendations.
Funding:
not relevant.
Trial Registration:
not relevant.
Insights
Pivmecillinam use for uncomplicated urinary tract infections (uUTIs) in Denmark increased significantly, while sulfamethizole use decreased. Actual antibiotic prescribing did not align with regional treatment guidelines, indicating poor adherence.
Area of Science:
- Pharmacology
- Infectious Diseases
- Public Health
Background:
- Uncomplicated urinary tract infections (uUTIs) are a frequent reason for primary care consultations.
- Treatment guidelines for uUTIs in Denmark have debated the use of sulfamethizole versus pivmecillinam.
- Regional variations in antibiotic recommendations and usage for uUTIs warrant investigation.
Purpose of the Study:
- To evaluate the regional use of sulfamethizole and pivmecillinam for uUTIs in Denmark between 2007 and 2011.
- To compare actual antibiotic prescribing patterns with regional recommendations for uUTI treatment.
Main Methods:
- Retrieved regional drug utilization data for pivmecillinam and sulfamethizole from 2007 to 2011.
- Identified regional uUTI treatment recommendations for the same period.
- Calculated antibiotic consumption in defined daily doses per 1,000 inhabitants per day (DID) to assess regional differences and trends.
Main Results:
- Sulfamethizole consumption decreased across all five Danish regions (0.4–0.6 DID absolute decrease).
- Pivmecillinam consumption showed a steady increase (1.5–2.5 DID absolute increase) and surpassed sulfamethizole use overall.
- Regional recommendations shifted from sulfamethizole-only to including pivmecillinam in some regions by 2010-2011.
Conclusions:
- Pivmecillinam became the dominant antibiotic for uUTI treatment in practice.
- A discrepancy exists between prevalent regional recommendations favoring sulfamethizole and the actual increased use of pivmecillinam.
- Findings suggest suboptimal adherence to regional uUTI treatment guidelines in Danish primary care.
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