Antibiotic Appropriateness on Mondays vs. Fridays: Empiric Treatment of Simple Cystitis in the Emergency Department

Authors

DOI:

https://doi.org/10.5195/ijms.2024.2105

Keywords:

Urinary Tract Infections, Cystitis, Antibiotics, Bacterial Drug Resistance, Emergency Medicine, Antibiotic Resistance, Emergency Service, Hospital, Drug Prescriptions, Anti-Bacterial Agents, Drug Utilization, Medication Adherence, Practice Guidelines as Topic, Retrospective Studies, Female, Adult, Drug Dosage, Drug Administration Schedule, Treatment Outcome, New York City, Outpatients, Infectious Diseases Society of America, Bacteriuria, Antibiotic Prophylaxis

Abstract

Background: The treatment of urinary tract infections (UTIs) has contributed to the rise of antibiotic resistance. Antibiotic appropriateness in the outpatient setting is lower than expected. We hypothesized that prescribing practices may vary based on the day of the week. We sought to determine the percentage of antibiotic prescriptions that met criteria for antibiotic appropriateness on Mondays vs. Fridays.

Methods: This is a retrospective cohort study of adult females with simple cystitis presenting to the Emergency Department (ED) between 2019 and 2021. We defined antibiotic appropriateness based on the Infectious Diseases Society of America guidelines in conjunction with a regional outpatient UTI antibiogram. Each prescription was assessed for drug selection, dose, frequency, and duration. Categorical data is reported as counts (%) and compared with chi-square. Nonparametric continuous data is reported as median (range) and compared with Mann-Whitney.

Results: 160 subjects were included: 80 came to the ED on a Monday and 80 on a Friday. Demographics were similar; except, more subjects had antibiotic allergies on Mondays. The number of appropriate antibiotic prescriptions was similar between Mondays and Fridays: 54 (68%) and 60 (75%), respectively (p=0.3). Overall, 44 subjects had an inappropriate duration of antibiotics and 14 subjects had an inappropriate antimicrobial prescribed, with no differences between Mondays and Fridays. Dose and frequency were always correct. In total, there were 46 (29%) antibiotics that failed to meet appropriateness criteria.

Conclusions: There was no difference in antibiotic appropriateness between Mondays and Fridays; however, 29% of prescriptions did not meet criteria for appropriateness.

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References

Schappert S, Rechtsteiner E. Ambulatory medical care utilization estimates for 2007. Vital Health Stat 13 2011;(169):1–38.

Albert X, Huertas I, Pereiro I, Sanfelix J, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev. 2004;3:CD001209.pub2

Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014;28(1):1-13.

Grover M, Bracamonte J, Kanodia A, Bryan M, Donahue S, Warner A, et al. Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. Mayo Clin Proc. 2007;82(2):181-5.

Paul R. State of the Globe: Rising Antimicrobial Resistance of Pathogens in Urinary Tract Infection. J Glob Infect Dis. 2018;10(3):117-118.

Gupta K, Hooton T, Naber K, Wullt B, Colgan R, Miller L, et al. Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-20.

Denny K, Gartside J, Alcorn K, Cross J, Maloney S, Keijzers G. Appropriateness of antibiotic prescribing in the Emergency Department. J Antimicrob Chemother. 2019;74(2):515-520.

Chardavoyne PC, Kasmire KE. Appropriateness of Antibiotic Prescriptions for Urinary Tract Infections. West J Emerg Med. 2020;21(3):633-639.

Huibers L, Moth G, Christensen M, Vedsted P. Antibiotic prescribing patterns in out-of-hours primary care: a population-based descriptive study. Scand J Prim Health Care. 2014;32(4):200-7.

Bishara J, Hershkovitz D, Paul M, Rotenberg Z, Pitlik S. Appropriateness of antibiotic therapy on weekends versus weekdays. J Antimicrob Chemother. 2007;60(3):625-8.

StatPearls. Acute Cystitis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459322. Last updated Jul 12, 2022; cited Aug 1, 2023.

New York City Antibiogram: 2016-2017 Urinary Tract Infections, Outpatient Antibiotic Susceptibility Data. Available from: https://www.nyc.gov/assets/doh/downloads/pdf/csi/antibiogram2017-citywide.pdf. Last updated 2017. Cited Aug 1, 2023.

Lane GI and Powell CR. AUA Core Curriculum: Urinary Tract Infection (Adult). Available from: https://university.auanet.org/core/urologic-infections/adult-urinary-tract-infection/index.cfm. Cited Aug 1, 2023.

Anger J, Lee U, Ackerman A, Chou R, Chughtai B, Clemens J, et al. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline. J Urol. 2019;202(2):282-289.

Nys C, Fischer K, Funaro J, Shoff C, Theophanous R, Staton C, et al. Impact of Education and Data Feedback on Antibiotic Prescribing for Urinary Tract Infections in the Emergency Department: An Interrupted Time-Series Analysis. Clin Infect Dis. 2022;75(7):1194-1200.

Bent S, Nallamothu B, Simel D, Fihn S, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002;287(20):2701-10.

Nicolle L, Gupta K, Bradley S, Colgan R, DeMuri G, Drekonja D, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):e83-e110.

The image is a horizontal grouped bar chart titled "Rate of Antibiotic Appropriateness on Mondays vs. Fridays, n= 160". It illustrates the proportion of appropriate antibiotic prescriptions across four categories: Duration, Frequency, Dose, and Selection, as well as an Overall rate. For each category, there are two adjacent bars representing data for Monday (in blue) and Friday (in orange). The chart shows that Monday generally has higher rates of appropriateness in all categories, with the most noticeable difference in the 'Selection' category. The 'Duration' and 'Frequency' categories show the least variation between the days. The proportions are marked on a scale from 0 to 100 on the horizontal axis.

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Published

2024-03-27 — Updated on 2024-04-12

How to Cite

LeBron, K. A., Bielawski, A., Popiel , P., Shams , S., & Grimes, C. L. (2024). Antibiotic Appropriateness on Mondays vs. Fridays: Empiric Treatment of Simple Cystitis in the Emergency Department. International Journal of Medical Students, 12(1), 29–34. https://doi.org/10.5195/ijms.2024.2105

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Vol. 12 No. 1 (2024)

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Original Article

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Copyright (c) 2024 Kira A. LeBron, Adrienne Bielawski, Patrick Popiel , Setareh Shams , Cara L. Grimes

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