title: Assessment of appropriate antibiotic prescribing for urinary tract infections in an internal medicine clinic.
abstract: OBJECTIVE
  Urinary tract infections (UTIs) are one of the most common infections encountered in ambulatory care and inpatient settings. Although these infections are common, not all patients are prescribed an appropriate antibiotic or duration of therapy. The primary objective of this analysis was to evaluate the appropriateness of antibiotic selection and duration of therapy for patients in an adult internal medicine clinic diagnosed as having a UTI.
  
  
  METHODS
  We conducted a retrospective chart review (July 1, 2012-June 30, 2013) of adult patients in an internal medicine clinic who were diagnosed as having a UTI. Pediatric and pregnant patients were excluded from the analysis. Data pertaining to the classification of UTI, antibiotic regimen, urine culture, and renal function were collected. All of the data were analyzed to determine whether the prescribing habits at the internal medicine clinic aligned with Infectious Diseases Society of America (IDSA) guidelines for antibiotic selection and duration of therapy for acute uncomplicated cystitis, complicated cystitis, catheter-associated UTI, and pyelonephritis.
  
  
  RESULTS
  There were 269 records available for the analysis, with the majority of the cases being uncomplicated and complicated UTIs. Of 128 cases of patients with uncomplicated UTIs and 116 cases of patients with complicated UTIs, 64.1% and 42.2%, respectively, were prescribed appropriate first- or second-line therapy, which aligned with the recommendations of the IDSA. Regarding the individual components of the UTI treatment regimen, antibiotic selection had the highest frequency of appropriateness, with 97.6% of uncomplicated UTI cases and 90.5% of complicated UTI cases having been treated with a recommended antibiotic. In contrast, the treatment duration for uncomplicated and complicated UTIs had the lowest frequency of appropriateness, at 71.9% and 58.6%, respectively.
  
  
  CONCLUSIONS
  Receiving an adequate antibiotic regimen for a UTI is important to prevent treatment failure and the emergence of resistant organisms. Overall, the studied antibiotic regimens prescribed for various UTIs diagnosed in the clinic did not align with the IDSA recommendations.
authors.affiliation: From the Medical University of South Carolina and the South Carolina College of Pharmacy, Charleston, South Carolina.
authors.forename: Meredith
authors.initials: M
authors.lastname: Sigler
authors.affiliation: From the Medical University of South Carolina and the South Carolina College of Pharmacy, Charleston, South Carolina.
authors.forename: Julie Ehret
authors.initials: JE
authors.lastname: Leal
authors.affiliation: From the Medical University of South Carolina and the South Carolina College of Pharmacy, Charleston, South Carolina.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bliven
authors.affiliation: From the Medical University of South Carolina and the South Carolina College of Pharmacy, Charleston, South Carolina.
authors.forename: Brittany
authors.initials: B
authors.lastname: Cogdill
authors.affiliation: From the Medical University of South Carolina and the South Carolina College of Pharmacy, Charleston, South Carolina.
authors.forename: Amy
authors.initials: A
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing; D007388:Internal Medicine / Q000592:standards*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents