title: Impact of a region wide antimicrobial stewardship guideline on urinary tract infection prescription patterns.
abstract: BACKGROUND
  Fluoroquinolones are frequently prescribed for non complicated urinary tract infection treatments and have a negative ecological impact. We aimed to substitute them by antibiotics with narrower activity spectrum in order to preserve fluoroquinolone activity in complicated hospital infections.
  
  
  OBJECTIVE
  To assess the impact of a multi-modal approach that combines the dispatching of antibiotic prescription guidelines and voluntary attendance at educational sessions on general practitioners' (GP) antibiotic prescription habits.
  
  
  METHODS
  This study was led in Franche-Comté, a French eastern region, where GPs were given a guideline recommending a restricted use of fluoroquinolones for urinary tract infections.
  
  
  METHODS
  Segmented regression analysis of interrupted time series was used to assess changes in antibiotic prescription.
  
  
  METHODS
  The antibiotic prescription data of nitrofurantoin, fosfomycin-trometamol and fluoroquinolones for women aged 15-65 years were obtained from the regional agency of health insurance.
  
  
  RESULTS
  Twenty months after intervention, the number of nitrofurantoin and fosfomycintrometamol prescriptions increased by 36.8% (95% CI: 30.6-42.2) and 28.5% (95% CI: 22.9-35.4), respectively, while that of norfloxacin decreased by 9.1% (95% CI: -15.3 to -3.5).
  
  
  CONCLUSIONS
  This study suggests that the dispatch of the guideline on urinary tract infection had a moderate impact on antibiotic prescriptions.
authors.affiliation: Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire Besançon, 3 Bd Fleming, 25030, Besancon, Cedex, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Slekovec
authors.forename: Joël
authors.initials: J
authors.lastname: Leroy
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vernaz-Hegi
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Faller
authors.forename: Danièle
authors.initials: D
authors.lastname: Sekri
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.forename: Daniel
authors.initials: D
authors.lastname: Talon
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertrand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D011307:Drug Prescriptions / Q000592:standards; D004363:Drug Utilization / Q000592:standards; D004502:Education, Medical, Continuing; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use; D005602:France; D058005:General Practitioners / Q000193:education / Q000592:standards*; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D009582:Nitrofurantoin / Q000627:therapeutic use; D009643:Norfloxacin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015397:Program Evaluation; D012044:Regression Analysis; D013997:Time Factors; D014552:Urinary Tract Infections / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D005578:Fosfomycin; D009582:Nitrofurantoin; D009643:Norfloxacin