123. Treatment Patterns and Prevalence of Inappropriate and Suboptimal Antibiotic Use Among Females with Uncomplicated Urinary Tract Infection in the US
Authors: Wang Yuexi , Mitrani-Gold Fanny S , Xie Lin , Jaiswal Mamta , Sun Xiaoxi , Joshi Ashish V 
Published: January 2021

Abstract

Background
Urinary tract infections (UTIs) are the most common bacterial infection requiring medical care. Despite Infectious Diseases Society of America (IDSA) 2011 guidelines on antimicrobial agent selection and duration of therapy for uncomplicated UTI (uUTI), prescribing practices vary. Few studies have used real-world data (RWD) to evaluate inappropriate and suboptimal antibiotic use among patients treated for uUTI. We examined the prevalence of potentially inappropriate and suboptimal use of antibiotics among females with uUTI.

Methods
This retrospective cohort study examined the first-line use of antibiotics in females (age ≥ 12 years) with diagnosed uUTI in the US, identified using RWD from IBM MarketScan (commercial and Medicare claims) Jan 1, 2013–Dec 31, 2017. Index date was the date of uUTI diagnosis. Patients were included based on criteria in Table 1 and assigned to one of two groups: appropriate and optimal; or inappropriate or suboptimal antibiotic use. As uUTI is often treated empirically, appropriate use was defined based on IDSA 2011 guidelines on drug class, dose and therapy duration; antibiotic use was considered suboptimal if there was evidence of treatment failure (Table 2).
Table 1. Key inclusion and exclusion criteria

Results
In total, 557,669 patients with uUTI were included in the study; see Table 3 for baseline characteristics. Overall, 88.7% had inappropriate or suboptimal antibiotic use (Table 4). Of these, 86.1% had inappropriate use only, 2.1% had suboptimal use only, and 11.9% had both. Inappropriate drug class assignment was observed in 53.4% of patients with inappropriate use, 83.7% of whom were administered fluoroquinolones (a second-line agent) as first-line therapy. Among patients with inappropriate therapy duration: most given trimethoprim/sulfamethoxazole received 5- (27.2%), 7- (42.1%) or 10- (27.8%) days’ supply rather than the recommended 3 days; the majority given nitrofurantoin were provided a 7- (80.5%) or 10- (13.4%) day supply rather than the recommended 5 days; and 46.2% given fosfomycin received 3-days’ supply instead of the recommended 1 day.
Table 3. Baseline characteristics

Table 4. Patient disposition

Conclusion
In the treatment of uUTI, the prevalence of inappropriate and/or suboptimal antibiotic use is very high which may have subsequent implications for patient health outcomes.

Disclosures
Yuexi Wang, M.Econ, GlaxoSmithKline plc. (Other Financial or Material Support, Funding)STATinMED Research (Employee) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Lin Xie, MS, MA, GlaxoSmithKline plc. (Other Financial or Material Support, Funding)STATinMED Research (Employee) Mamta Jaiswal, PhD, GlaxoSmithKline plc. (Other Financial or Material Support, Funding)STATinMED Research (Employee) Xiaoxi Sun, MA, GlaxoSmithKline plc. (Other Financial or Material Support, Funding)STATinMED Research (Employee) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)