title: Different patterns in use of antibiotics for lower urinary tract infection in institutionalized and home-dwelling elderly: a register-based study.
abstract: OBJECTIVE
  We compared the quality and pattern of use of antibiotics to treat urinary tract infection (UTI) between institutionalized and home-dwelling elderly.
  
  
  METHODS
  We analyzed the quality of use of UTI antibiotics in Swedish people aged ≥ 65 years at 30 September 2008 (1,260,843 home-dwelling and 86,721 institutionalized elderly). Data regarding drug use, age and sex were retrieved from the Swedish Prescribed Drug Register and information about type of housing from the Social Services Register. In women, we assessed: (1) the proportion who use quinolones (should be as low as possible); (2) the proportion treated with the recommended drugs (pivmecillinam, nitrofurantoin, or trimethoprim) (proportions should be about 40 %, 40 % and 15-20 %, respectively); In men, we assessed: (1) the proportion who used quinolones or trimethoprim (should be as high as possible).
  
  
  RESULTS
  The 1-day point prevalence for antibiotic use for UTI was 1.6 % among institutionalized and 0.9 % among home-dwelling elderly. Of these, about 15 % of institutionalized and 19 % of home-dwelling women used quinolones. The proportion of women treated with the recommended drugs pivmecillinam, nitrofurantoin or trimethoprim was 29 %, 27 % and 45 % in institutions and 40 %, 28 % and 34 % for home-dwellers. In men treated with antibiotics for UTI, quinolones or trimethoprim were used by about 76 % in institutions and 85 % in home-dwellers.
  
  
  CONCLUSIONS
  Our results indicate that recommendations for UTI treatment with antibiotics are not adequately followed. The high use of trimethoprim amongst institutionalized women and the low use of quinolones or trimethoprim among institutionalized men need further investigation.
authors.affiliation: Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden. Ylva.Haasum@ki.se
authors.forename: Ylva
authors.initials: Y
authors.lastname: Haasum
authors.forename: Johan
authors.initials: J
authors.lastname: Fastbom
authors.forename: Kristina
authors.initials: K
authors.lastname: Johnell
mesh_terms: D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000639:trends; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence; D006707:Homes for the Aged; D006801:Humans; D057187:Independent Living; D007326:Institutionalization; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012737:Sex Factors; D013548:Sweden; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents