157. Outpatient Antibiotic Prescribing Practices for Uncomplicated Urinary Tract Infections in Women in the United States, 20012010
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall

Background:

The 2011 Infectious Diseases Society of America guideline recommends nitrofurantoin or trimethoprim-sulfamethoxazole as first-line agents for the empiric treatment of uncomplicated urinary tract infection (UTI); fluoroquinolones (FQ) are considered a second-line choice, but there have been concerns for overprescribing. Our study objectives were to describe trends in antibiotic prescribing for outpatient UTI visits in women and to identify factors associated with FQ prescribing.

Methods:

We used the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS) datasets from 20012010. Outpatient visits for uncomplicated UTIs in women ≥18 years were included. We examined time trends in antibiotic prescribing and used multivariable logistic regression to identify patient and provider factors associated with FQ prescribing.

Results:

A total of 7,597 visits were identified; 81% of visits resulted in an antibiotic prescription. FQ were the most frequently prescribed antibiotics (48% for all years) followed by sulfonamides (27%) and nitrofurantoin (19%). No temporal trends were observed in antibiotic selection patterns (Figure). FQ were the most common class selected for all subpopulations. Older patients and patients treated by internists were more likely than younger patients and those treated by other providers to receive FQ (Table).

Conclusion:

Despite existing guidelines, FQ are being used as first-line agents for uncomplicated UTI in women. Outpatient antibiotic stewardship initiatives should include efforts to reduce overuse of FQ for uncomplicated UTIs, including internists as a target audience.

Table: Multivariable analysis of factors associated with FQ prescribing

Characteristics

% FQ prescription

Adjusted odds ratio

P value

Patient age group (years)

1829

37

1.0

<0.001

3049

51

1.6 (1.22.1)

5069

52

1.6 (1.22.1)

≥70

56

1.9 (1.3 2.7)

Race

White

48

1.0

0.67

Black

47

1.0 (0.71.4)

Other

41

0.7 (0.41.3)

Insurance

Private

49

1.0

0.18

Medicare/Medicaid

48

0.7 (0.60.9)

Other

41

0.8 (0.61.2)

Provider specialty1

Family/general practice

47

1.0

<0.01

Internal medicine

63

1.6 (1.12.5)

Urology

43

0.4 (0.30.7)

Other

45

0.5 (0.30.9)

1.       Data available for NAMCS only

Miwako Kobayashi, MD, MPH1, Daniel Shapiro, BA2, Adam L. Hersh, MD, PhD3, Guillermo Sanchez, PA-C, MPH, MSHS1 and Lauri Hicks, DO1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)University of California San Francisco School of Medicine, San Francisco, GA, (3)University of Utah School of Medicine, Salt Lake City, UT

Disclosures:

M. Kobayashi, None

D. Shapiro, None

A. L. Hersh, Pfizer: Grant Investigator , Grant recipient and Research grant

G. Sanchez, None

L. Hicks, None

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