title: Cystitis: antibiotic prescribing, consultation, attitudes and opinions.
abstract: BACKGROUND
  Despite stable overall antibiotic use between 2007 and 2011 in The Netherlands, use of nitrofurantoin and trimethoprim increased by 32%. The background of this increased antibiotic use against uropathogens is unknown.
  
  
  OBJECTIVE
  To determine whether increased use of urinary tract infection antibiotics is caused by changes in patients' consultation or physicians' prescribing behaviour and to investigate attitudes and opinions of women with respect to cystitis management and antibiotics.
  
  
  METHODS
  Consultation and prescribing for International Classification of Primary Care (ICPC) codes U01 (dysuria), U02 (frequency), U05 (other urination problems), U70 (pyelonephritis) and U71 (cystitis) were determined from 2007 to 2010, using routinely collected primary health care data. Separately, behaviour of women with respect to managing cystitis, consultation and opinions towards (delayed) antibiotic treatment were studied using questionnaires in 2012.
  
  
  RESULTS
  Consultation for U02 and U71 significantly increased from 93 to 114/1000 patient-years from 2007 to 2010; proportion of episodes in which an antibiotic was prescribed remained constant. Questionnaires revealed that urination problems and pain were dominant complaints of cystitis; pain medication, however, was not adequately used. One-third of women directly consult upon first symptoms, whereas the majority awaits an average of 4 days. Sixty-six per cent of women report to be willing to postpone antibiotic use.
  
  
  CONCLUSIONS
  Increased use of urinary tract infection antibiotics may be caused by increased consultation for cystitis in primary care. Future research should focus on the outcomes of adequate pain medication, enhanced diagnostic procedures and of delaying antibiotic use in cystitis management.
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Carmen S J
authors: CS
authors: Willems
authors: Joep
authors: J
authors: van den Broek D'Obrenan
authors: Mattijs E
authors: ME
authors: Numans
authors: Theo J M
authors: TJ
authors: Verheij
authors: Alike W
authors: AW
authors: van der Velden
mesh_terms: D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D001294:Attitude to Health; D003556:Cystitis / Q000188:drug therapy*; D004363:Drug Utilization / Q000639:trends; D053159:Dysuria / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D009582:Nitrofurantoin / Q000627:therapeutic use; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014295:Trimethoprim / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000892:Anti-Infective Agents, Urinary; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin; D014295:Trimethoprim
keywords: Antibiotics; attitudes; consultation; cystitis; prescribing; primary health care.