General practitioners do not systematically adhere to regional recommendations on treatment of uncomplicated urinary tract infections - Abstract

INTRODUCTION: Uncomplicated urinary tract infection (uUTI) is a common reason for seeing a GP.

In Denmark, it is debated if sulfamethizole or pivmecillinam should be recommended for empirical treatment of uUTIs. We evaluated sulfamethizole and pivmecillinam use in the five Danish regions from 2007 to 2011 and explored if the choice of antibiotic in primary care was in accordance with the regional recommendations for uUTI.

MATERIAL AND METHODS: Regional drug use data on pivmecillinam and sulfamethizole from 2007 to 2011 were retrieved from the Registry of Medicinal Product Statistics. Regional recommendations from the same period were identified. We calculated differences in consumption based on defined daily doses per 1,000 inhabitants per day (DID) of pivmecillinam and sulfamethizole between the five regions, and intraregional developments.

RESULTS: Four regions had recommendations on uUTI in 2011. From 2007 to 2009, sulfamethizole was the only antibiotic recommended. Pivmecillinam was recommended along with sulfametizole in one of four regions from 2010, which increased to two regions in 2011. During the five-year period, sulfamethizole consumption decreased in all regions. The absolute decrease ranged from 0.4 to 0.6 DID. Pivmecillinam consumption increased steadily; the absolute increase ranged from 1.5 to 2.5 DID. During the whole period, the total pivmecillinam consumption was higher than the total sulfamethizole consumption.

CONCLUSION: Pivmecillinam dominated the treatment of uUTIs, whereas sulfamethizole prevailed in the regional recommendations, which suggests a lack of adherence to regional recommendations.

Written by:
Christoffersen T, Bjerrum L, Nielsen AB.   Are you the author?
Section and Research Unit of General Practice, Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark.

Reference: Dan Med J. 2014 Apr;61(4):A4814.

PubMed Abstract
PMID: 24814591 Infections Section