Programme no. 340-OP
Quality Improvement
Do Denmark, Sweden and other countries agree on recommendations for empiric first-choice antibiotic treatment of uncomplicated urinary tract infections?
Josephine M. Haslund*1, Marianne R. Dinesen2, Anni B.S. Nielsen*3, Carl Llor4, Lars Bjerrum5
1Section and Research Unit of General Practice, Department of Public Health,University of Copenhagen, Denmark,Copenhagen,Denmark, 2Section and Research Unit of General Practice, Department of Public Health,University of Copenhagen, Denmark,Copenhagen,Denmark, 3Section and Research Unit of General Practice, Department of Public Health,University of Copenhagen, Denmark,Copenhagen,Denmark, 4University Rovira I Virgili, Tarragona,Spain, 5Section and Research Unit of General Practice, Department of Public Health,University of Copenhagen, Denmark,Copenhagen,Denmark
* = Presenting author
Objectives: To compare national recommendations from European countries including Denmark and Sweden, and to examine recommendations for first-choice AB therapy of uUTI.
Background: Uncomplicated urinary tract infection (uUTI) is a common reason for antibiotic (AB) treatment in general practice (GP). The pattern of microbial resistance and the use of ABs vary between countries. During the last decade the resistance rate of E. coli to fluoroquinolone has increased mainly among Southern European countries. In Scandinavia, eg Denmark and Sweden, increasing resistance rate of E. coli to sulphamethizole and ampicillin is seen. All over Europe, E. coli is the most frequent aetiology of uUTI. The increasing antimicrobial resistance causes complications and increased mortality rates, this makes it important to agree on the most appropriate ABs for empiric first choice treatment.
Results: The 6 countries recommended 7 different ABs. 5 countries incl. Denmark and Sweden, recommended over one AB as first-choice treatment. Denmark and Sweden both recommended pivmecillinam as first-choice, and Sweden nitrofurantion too. Denmark was the only country recommending sulphamethizole, and Spain the only recommending fluoroquinolone and amoxicillin/clavulanic acid. 3 countries recommended ABs with a high rate (>10–20%) of resistant E. coli. All countries recommended minimum one AB with a low (< 5%) resistance rate.
Material/Methods: Recommendations from GP in 6 European regions were examined: North (Denmark, Sweden), West (Scotland), Central (Germany), South (Spain), and East (Croatia). Searches were done on PubMed, the Cochrane Library databases, Google, and Google Scholar.
Conclusion: Considerable differences in recommendations for empiric first-choice AB treatment of uUTI was found. The differences in first-choice treatment of uUTI, could not be explained by differences in local bacterial aetiology or by different patterns of antimicrobial resistance. Despite resistance rates >10–20%, sulphamethizole, trimethoprim or fluoroquinolones were recommended in 3 of 6 countries.
Points for discussion: How can we reduce and control the increasing antimicrobial resistance? What do GPs need in order to reduce inappropriate AB prescribing for uUTIs in the Nordic countries?