[Repeat antibiotic prescriptions following treatment with sulfonamide or pivmecillinam. A survey of prescriptions among women aged 15-50 years in the county of Nordjylland].
BACKGROUND
A sulphonamide is the antibiotic of first choice for the treatment of uncomplicated urinary tract infections in Denmark. However, this recommendation has been challenged.


METHODS
The study comprised 9,224 women, aged 15 to 50 years, who were residents in the County of North Jutland, Denmark. During 1997-1998 they had handed in a prescription from a general practitioner for either sulphonamide or pivmecillinam, but no other prescriptions for antibiotics during the preceding six months. Any antibiotic prescription handed in within the ensuing 31-day period was recorded, with the exception of macrolides. The proportion of women with a repeat prescription was a proxy for therapeutic failure.


RESULTS
Eight thousand two hundred and sixty-nine women (89.6%) had handed in a prescription for a sulphonamide and 955 (10.4%) a prescription for pivmecillinam. A total of 1,490 women (16.2%) handed in a repeat prescription, i.e. 16.0% (95% confidence limits [CI] 15.2-16.8%) of women treated with sulphonamide and 17.8% (95% CI 15.4-20.4%) of women treated with pivmecillinam. The relative risk of a repeat prescription was 1.11 (95% CI 0.95-1.31) for women with a primary prescription for pivmecillinam, as compared to women with a sulphonamide prescription. Women who had handed in a sulphonamide prescription for less than three defined daily doses had an increased risk of a repeat prescription.


CONCLUSIONS
The proportion of women with a repeat prescription did not differ much between women treated with sulphonamide and those treated with pivmecillinam. Controlled clinical trials should be performed before revision of current Danish recommendations are considered.
Schønheyder
H C
HC
Klinisk mikrobiologisk afdeling, Aalborg Sygehus afsnit Syd, DK-9000 Aalborg. prof1@aas.nja.dk
Thrane
N
N
Sørensen
H T
HT
D000293:Adolescent; D000328:Adult; D000561:Amdinocillin Pivoxil / Q000008:administration & dosage*; D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage*; D003718:Denmark; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D013449:Sulfonamides / Q000008:administration & dosage*
D000892:Anti-Infective Agents, Urinary; D010406:Penicillins; D013449:Sulfonamides; D000561:Amdinocillin Pivoxil