According to a new study, in the entire United States, in both rural and urban settings, most women with private health insurance receive inadequate treatment for their urinary tract infections (UTIs).
Of the 670,450 women included in this research, who had been diagnosed with uncomplicated UTI between the ages of 18 and 44, nearly half received the wrong antibiotics and more than three-quarters were prescribed the drug for too long. time. (An ITU is declared “uncomplicated” when the patient has no abnormality or disease that may predispose him to more frequent infections).
The results are largely consistent from place to place, although patients in more rural settings were more likely to receive antibiotics for longer.
Throughout the study, from 2011 to 2015, there was only a slight improvement in appropriate antibiotic prescriptions based on current clinical guidelines.
“Inadequate antibiotic prescriptions for uncomplicated urinary tract infections are common and have serious consequences at the patient and society level,” says epidemiologist Anne Mobley Butler of Washington University School of Medicine, St. Louis. Louis.
“The results of our study underscore the need for antimicrobial stewardship interventions to improve the prescription of outpatient antibiotics, especially in rural settings.”
The research was funded in part by several pharmaceutical companies, including Sanofi Pasteur, Pfizer and Merck. The results were reviewed in pairs and are largely in line with the results of previous studies, which suggest that up to 60 percent of antibiotics prescribed in intensive care units are “unnecessary, inappropriate, or suboptimal.”
Nor is this just a problem in the US. Worldwide, UTIs are one of the most common infections leading to emergency room visits. In the UK, it is the second most common reason to prescribe antibiotics.
Taking the wrong antibiotic not only has worse results for each patient, but longer prescriptions are not necessarily better and can make bacteria grow resistant, making recurrence more likely and future infections more difficult. treat.
Today it is estimated that one in three uncomplicated UTIs in women is resistant to the popular combined antibiotic Bactrim (sulfamethoxazole and trimethoprim) and one in five is resistant to another five common antibiotics.
It is difficult to estimate the number of deaths related to antibiotic-resistant UTIs due to lack of research and follow-up, but some studies suggest that about 13,000 lives a year could be lost in U.S. hospitals alone. And some people suffer from recurrent and resistant infections for years and years with little or no relief.
In light of these emerging concerns, in 2010 the Society for Infectious Diseases of America (IDSA) and the European Society of Microbiology and Infectious Diseases updated their clinical practice guidelines. Based on the results of several studies, they now recommend several first-line and long-lasting antibiotics to better treat UTIs and minimize the risk of antibiotic resistance.
This advice, however, is clearly not available to doctors and health professionals. Many continue to prescribe antibiotics not recommended for inappropriate durations.
Finding out where the most inappropriate prescriptions are occurring could help us target areas where we need to improve adherence to antibiotic guidelines. In the United States, rural areas experience numerous health disparities compared to more urban areas, although this is the first large-scale study to assess how this affects the treatment of UTIs.
The authors are unsure why longer antibiotic treatments for UTIs are especially common in rural areas, but suggest it may have to do with access to physician care and awareness. In rural areas, women can receive longer prescriptions to avoid future trips if this treatment fails.
Studies also show that late-career physicians are more common in rural areas and are more likely to prescribe antibiotics for longer, possibly because they have not heard of up-to-date guidelines.
“The accumulation of evidence suggests that patients have better outcomes when we move on to prescribing broad-spectrum antibiotics with a narrow spectrum and longer to shorter durations,” explains Butler.
“Promoting optimal use of antimicrobials benefits the patient and society by avoiding preventable adverse events, microbiome alterations, and antibiotic-resistant infections.”
When up to 60 percent of women may suffer from a UTI at some point in their lives, it is clear that it is vital that guidelines for treatment be better applied, especially as antibiotic resistance increases.
This particular study was only based on commercially insured people, which means that those people who do not have insurance or who receive public insurance were not taken into account. Rural areas were also infrequently defined, including small towns and suburbs on the edge of urban areas, and men were not included, who also suffer from urinary tract infections (albeit at a slower rate).
Future research should focus on filling these gaps, but in the meantime, the trend reinforces the idea that physicians need to periodically review clinical practice guidelines, even for common situations they have been treating for years.
“In recent years, little effective progress has been made in reducing the inappropriate prescription of antibiotics for ITU without complications,” the new paper concludes.
“Given the large number of inappropriate prescriptions made annually in the United States, as well as the negative consequences at the patient and society level of unnecessary exposure to antibiotics, antimicrobial custody interventions are needed to improve the antibiotic prescription Outpatient ITUs, particularly in rural settings “.
The study was published in Infection control and hospital epidemiology.