Antibiotic prescribing for cystitis: how well does it match published guidelines?
OBJECTIVE
Cystitis is one of the most common bacterial infections seen by physicians in outpatient settings. Published clinical guidelines by the Infectious Disease Society of America and other organizations have been established to enable effective treatment, while attempting to decrease cost and limit antibiotic resistance.


METHODS
Insurance claims data for employees and dependents of a single Midwest corporation, with Preferred Provider Organization coverage, diagnosed with cystitis between 1996 and 1999 were matched to prescription drug claims for those who filled an antibiotic prescription within 3 days of diagnosis.


RESULTS
For acute and recurrent cystitis physicians prescribed trimethoprim-sulfamethoxazole 37% and 18% respectively. The other most common antibiotics prescribed were the broad-spectrum flouroquinolones, and nitrofurantoin. The mean duration for these prescriptions was 10 days regardless of whether the infection was acute or recurrent.


CONCLUSIONS
The first line recommended antibiotic, trimethoprim-sulfamethoxazole, was prescribed in 37% of acute infections, and for considerably longer than the suggested 3-day course of therapy. Steps should be taken to educate physicians and patients on the choice and dosage of antibiotics for cystitis to minimize emergence of antibiotic resistance.
McEwen
Laura N
LN
From the Department of Epidemiology, The University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
Farjo
Rand
R
Foxman
Betsy
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D003556:Cystitis / Q000188:drug therapy*; D004351:Drug Resistance; D017723:Drug Utilization Review; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D008511:Medicine / Q000145:classification / Q000706:statistics & numerical data; D008875:Middle Aged; D015146:Midwestern United States; D009582:Nitrofurantoin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011243:Preferred Provider Organizations / Q000592:standards*; D013038:Specialization; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000892:Anti-Infective Agents, Urinary; D024841:Fluoroquinolones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin