gms | German Medical Science

Background: Urinary tract infections (UTI) are a common reason for a doctor’s consultation and also for a subsequent antibiotic prescription. Recommendations for antibiotic use are published in the respective guidelines. Due to, among others, resistance rates and safety concerns, explicit recommendations against the use of fluoroquinolones (FQ) in uncomplicated UTI have been issued internationally and in Germany. Further, in 2018 and 2019, “Dear Doctor Letters” recommending a restricted FQ use were sent out to inform physicians individually. However, it is unclear, whether antibiotic prescribing in Germany changed following these recommendations and if trends differed between the physician specialties involved in diagnosing and treating UTI (e.g. general practitioners (GP), urologists or gynecologists).

Materials and methods: We used data from a local statutory health insurance (SHI) company, which covered about 38% of all SHI-insured persons in the federal state of Bremen between 2015 and 2019. The study population included all persons with at least one outpatient UTI diagnosis during the study period. Data further comprised patient demographics, information on the diagnosing and prescribing physicians and filled prescriptions. UTI cases and antibiotic treatment were assessed on a quarterly level.

Results: Overall, 102,715 UTI cases were diagnosed (78.6% female and 94% aged 18 years and older). Females received their diagnosis most often from GPs (52.2%), followed by urologists (20.0%) and gynecologists (16.1%), whereas UTI in males were mainly diagnosed by urologists (53.8%) and GPs (38.3%). Antibiotics were prescribed in 65.9% of female and 48.3% of male cases. The most commonly used drugs were FQ (26.3% of all antibiotic prescriptions), followed by fosfomycin (16.1%) and sulfamethoxazole/trimethoprim (14.2%). From the first quarter of 2015 to the last quarter of 2019, shares of FQ prescriptions by GPs decreased from 35.4% to 12.7%, while fosfomycin increased (9.1% to 18.8%) as did pivmecillinam. Shares of FQ prescriptions by urologists declined (43.3% to 14.7%) which was partly compensated by an increasing use of sulfamethoxazole/trimethoprim (9.8% to 15.6%). A decrease of FQ prescriptions was also observed in gynecologists (15.9% to 3.7%) whereas fosfomycin shares increased (from 44.6% to 52.3%).

Conclusion: We saw an overall trend towards a more guideline-adherent antibiotic UTI treatment which may be partly explained by the respective recommendations or the “Dear Doctor Letters”. Antibiotic treatment and trends differed between physician specialties with an overall higher uptake of guideline-recommended antibiotics by gynecologists, mainly because of higher prescription shares of fosfomycin which was probably influenced by patients’ characteristics and also the drug’s approval status.