Impact of an evidence-based order panel on antibiotic prescribing in ambulatory patients with cystitis

Optimizing antibiotic prescribing for urinary tract infections (UTI) represents an opportunity for ambulatory antibiotic stewardship programs (ASPs). A pre-populated order panel for UTI was implemented in the Mayo Clinic Enterprise in May 2022. The order panel provides antibiotic regimens aligning with institutional guidelines according to patient characteristics, presence or absence of complicating features, and antimicrobial allergy status. We assessed impacts of panel use on prescribing practices for cystitis.

This retrospective cohort study of ambulatory encounters with a primary diagnosis of cystitis from May 16, 2022, to May 15, 2023, compared encounters in which the order panel was utilized to encounters managed without the panel. The primary outcome was concordance with institutional guidelines, including drug selection, dose/frequency, and duration. Secondary outcomes included rate of repeat healthcare contact for UTI within 14 days and total duration of therapy.

793 randomly selected patient encounters (397 panel and 396 non-panel) were included. Prescribing was guideline adherent in 79.3% and 64.9% (P < 0.001) of panel and non-panel encounters, respectively. There were more 3- and 5-day treatment courses in the panel cohort; however, inappropriate duration of therapy was the most common reason for non-concordance in both cohorts. There was no significant difference between groups in repeat 14-day healthcare contact for UTI (13.4% panel vs 11.1% no panel, P = 0.34).

Use of a pre-populated ambulatory order panel for the treatment of cystitis was associated with greater concordance with institutional guidelines, without adversely impacting repeat healthcare contact for UTI.