Across the United States, both in rural and urban areas, most women with private health insurance receive inadequate treatment for urinary tract infections (UTIs), according to a new study.
Of the 670,450 women included in this research, who were diagnosed with uncomplicated UTIs 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. (An UTI is declared “uncomplicated” when the patient does not have any abnormalities or diseases that could predispose them to more frequent infections.)
The results are largely consistent from location to location, although patients in more rural settings have been more likely to be prescribed antibiotics for longer.
During the study, from 2011 to 2015, there was only a slight improvement in appropriate antibiotic prescriptions based on current clinical guidelines.
“Inappropriate antibiotic prescriptions for uncomplicated urinary tract infections are widespread and have serious patient and societal consequences,” said epidemiologist Anne Mobley Butler of the University of Washington School of Medicine, St. Louis. Louis.
The results of our study highlight the need for antimicrobial administration interventions to improve the prescription of outpatient antibiotics, especially in rural areas.
The research was partially funded by several pharmaceutical companies, including Sanofi Pasteur, Pfizer and Merck. The results were evaluated by colleagues and largely fall 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.”
This is not just a problem in the US either. Worldwide, UTIs are one of the most common infections leading to emergency room visits. In the United Kingdom, it is the second most common reason for prescribing antibiotics.
Not only does taking the wrong antibiotic have poorer results for every patient, longer prescriptions are not necessarily better and can cause bacteria to become resistant, making recurrence more likely and future infections more difficult to treat.
Today, it is estimated that one in three uncomplicated UTIs in women is resistant to the popular combination antibiotic Bactrim (sulfamethoxazole and trimethoprim), and one in five is resistant to five other common antibiotics.
An estimate of the number of antibiotic-resistant UTI-related deaths is difficult to establish due to a lack of research and monitoring, but some studies suggest that around 13,000 lives a year could be lost in American hospitals alone. And some people have been suffering from recurrent and resistant infections for years, with little or no relief.
In view of these emerging concerns, in 2010 the Society for Infectious Diseases of America (IDSA) and the European Society for Microbiology and Infectious Diseases updated their clinical practice guidelines. Based on the results of various studies, they now recommend several first-line and long-lasting antibiotic agents to best treat UTIs, while minimizing the risk of antibiotic resistance.
However, those tips are not clearly passed on to doctors and healthcare professionals. Many still prescribe antibiotics not recommended for inappropriate durations.
Finding out where the most inappropriate prescriptions happen could help us target areas where we need to improve compliance with antibiotic guidelines. In the US, rural areas face many health disparities compared to more urban areas, and yet this is the first large-scale study to assess how this impacts ITU treatment.
The authors are not sure why longer antibiotic treatments for UTIs are prevalent, especially in rural areas, but suggest that they may be related to access to care and physician awareness. In rural areas, women can be given longer prescriptions to avoid future trips if treatment fails.
Studies also show that late-career doctors are more prevalent in rural areas and are more likely to prescribe antibiotics longer, probably because they have not heard of updated guidelines.
The accumulation of evidence suggests that patients perform better when we change prescriptions from broad-acting antibiotics to narrow-spectrum antibiotics and from longer to shorter durations, Butler explains.
Promoting optimal antimicrobial use benefits the patient and society by preventing preventable adverse events, disrupting microbiomes, and antibiotic-resistant infections.
When up to 60 percent of women may suffer from UTI at some point in their lives, it is clearly vital that treatment guidelines be better implemented, especially as antibiotic resistance increases.
This special study was based only on commercially insured persons, which means that those who are not insured or who receive public insurance were not taken into account. Rural areas were also poorly defined, including small towns, as well as “suburbs” on the outskirts of urban areas, and men, who also suffer from UTI (albeit at a lower rate), were not included.
Future research should focus on filling these gaps, but in the meantime, the trend reinforces the idea that clinicians need to periodically review clinical practice guidelines, even for the common conditions they have been dealing with for years.
In recent years, little effective progress has been made to reduce the inadequate prescription of antibiotics for uncomplicated UTIs, the new paper concludes.
“Given the large number of inadequate prescriptions annually in the United States, as well as the negative patient and societal consequences of unnecessary antibiotic exposure, antimicrobial administration is needed to improve the prescription of outpatient ITU antibiotics, especially in the rural.”
The study was published in Infection control and hospital epidemiology.