[Impact of regional guidelines on the management of urinary tract infections with antibiotics].
OBJECTIVE
We assessed the impact of a committed guideline at the end of the first quarter 2008 on the management of urinary tract infection (UTI) with antibiotic prescription (fluoroquinolone, fosfomycin, and nitrofurantoin), by analysing reimbursement data for ambulatory care provided by the regional health insurance agency.


RESULTS
During the survey, we observed a 13.2% decrease of norfloxacin prescriptions between the first quarter 2008 and the first quarter 2009. The (fosfomycin+nitrofurantoin)/norfloxacin ratio increased between the third quarter 2007 and the first quarter 2009 from 0.55 to 0.72 and from 0.82 to 1.13 for general practitioners and hospital physicians respectively. The global number of patients treated with these antibiotics remained stable during the period. The number of fluoroquinolone prescription was stable between the first quarter 2008 and the first quarter 2009 with 28,427 DDD and 28,363 DDD, respectively; while the number of single dose rise in the same time from 151 DDD to 427.5 DDD, respectively.


CONCLUSIONS
The three messages which seem to be essential for an optimal use of fluoroquinolones in UTIs are: no treatment for bacterial colonisation (asymptomatic bacteriuria) except for specific cases, no indication for fluoroquinolones in non-complicated acute cystitis and for elderly women, UTI is complicated only if it occurs in women with co-morbidities regardless of age.


CONCLUSIONS
Our indicators suggest that our guideline had an impact on the prescription of fluoroquinolones for uncomplicated acute cystitis.
Ruyer
O
O
Service de maladies infectieuses et réanimation, centre hospitalier de Belfort-Montbéliard, Belfort-Montbéliard, France.
Slekovec
C
C
Bertrand
X
X
Faller
J-P
JP
Hoen
B
B
Talon
D
D
Leroy
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019468:Disease Management; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D005578:Fosfomycin / Q000627:therapeutic use*; D005602:France; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008875:Middle Aged; D009582:Nitrofurantoin / Q000627:therapeutic use*; D010821:Physicians, Family / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013997:Time Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000191:economics
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D005578:Fosfomycin; D009582:Nitrofurantoin