Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Inappropriate Antibiotic Use in Uncomplicated UTIs

Open Forum Infect Dis; ePub 2018 Aug 10; Durkin, et al

In a large cohort of women diagnosed with urinary tract infections (UTI), inappropriate antibiotic prescribing was common, with almost half of antibiotics prescribed being non-first-line agents and over three quarters prescribed for an inappropriate use. This according to retrospective cohort study of outpatient and emergency department (ED) visits within a commercial insurance database between January 1, 2009 and December 31, 2013. Researchers performed interrupted time series analyses to determine the impact of the Infection Diseases Society of America 2011 clinical practice guideline (CPG) on the appropriateness of antibiotic agent and duration. They found:

  • 654,432 women (aged 18-44 years) diagnosed with UTI were included.
  • Fluoroquinolones, non-first-line agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines.
  • There was a wide variation in the duration of treatment, with >75% of prescriptions for non-recommended treatment durations.
  • The CPG had minimal impact on provider antibiotic prescribing behavior.


Durkin MJ, Keller M, Butler AM, et al. An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections. [Published online ahead of print August 10, 2018]. Open Forum Infect Dis. doi:10.1093/ofid/ofy198.

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