title: Comparative effectiveness of different oral antibiotics regimens for treatment of urinary tract infection in outpatients: an analysis of national representative claims database.
abstract: There are very limited data on the postmarketing outcome comparison of different guideline antibiotic regimens for patients with urinary tract infections (UTIs). We carried out a population-based comparative effectiveness study from year 2000 through 2009, using the administrative data of 2 million patients from the National Health Informatics Project of Taiwan. Treatment failure was defined as either hospitalization or emergency department visits for UTI. Odd ratios were computed using conditional logistic regression models matched on propensity score. We identified 73,675 individuals with UTI, of whom 54,796 (74.4%) received trimethoprim-sulfamethoxazole (TMP-SMX), 4184 (5.7%) received ciprofloxacin, 3142 (4.3%) received levofloxacin, 5984 (8.1%) received ofloxacin, and 5569 (7.6%) received norfloxacin. Compared with TMP-SMX, the composite treatment failure was significantly lowered for norfloxacin in propensity score (PS) matching analyses (OR, 0.73; 95% CI, 0.54-0.99). Both norfloxacin (PS-matched OR, 0.68; 95% CI, 0.47-0.98) and ofloxacin (PS-matched OR, 0.70; 95% CI, 0.49-0.99) had significantly lowered composite treatment failure rate when compared with ciprofloxacin. Subgroup analysis suggested that both norfloxacin and ofloxacin were more effective in female patients without complications (W/O indwelling catheters, W/O bedridden status and W/O spinal cord injury), when compared with either TMP-SMX or ciprofloxacin. Among outpatients receiving oral fluoroquinolone therapy for UTIs, there was evidence of superiority of norfloxacin or ofloxacin over ciprofloxacin or TMP-SMX in terms of treatment failure. Given the observational nature of this study and regional difference in antibiotic resistance patterns, more studies are required to validate our results.
authors.affiliation: From the Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan (M-TGL, Sh-HL, C-CF, S-CC, C-CL); Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (S-SC); Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan (S-SC); Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital (Si-HL); Department of Rehabilitation and Physical Medicine, National Yang-Ming University, Taipei, Taiwan (Si-HL); Medical Wisdom Inc, US (ML); and Department of Emergency Medicine and Department of General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan (C-CL).
authors.forename: Meng-Tse Gabriel
authors.initials: MG
authors.lastname: Lee
authors.forename: Shih-Hao
authors.initials: SH
authors.lastname: Lee
authors.forename: Shy-Shin
authors.initials: SS
authors.lastname: Chang
authors.forename: Si-Huei
authors.initials: SH
authors.lastname: Lee
authors.forename: Matthew
authors.initials: M
authors.lastname: Lee
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Fang
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010045:Outpatients; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013624:Taiwan; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents