SAN FRANCISCO – Concerns about antibiotic resistance may be driving more physicians to prescribe second-line antibiotics for uncomplicated cystitis in women, a new study indicates.
Between 1998 and 2009, outpatient prescribing of first-line antibiotics for uncomplicated cystitis in women remained constant – yet the number of quinolone prescriptions grew significantly, results from an analysis of national data demonstrated.
Jessina C. McGregor, Ph.D.
The findings "reinforce what our gut instincts have been saying about prescribing for cystitis: Physicians are having more concerns about resistance and are therefore going to the second-line agents like quinolones, cephalosporins, and other medications," Jessina C. McGregor, Ph.D., said in an interview during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Dr. McGregor and her associates analyzed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, which are nationally representative surveys of ambulatory and emergency department visits. They focused their study on women over age 17, and used linear tests to analyze trends in rates of visits for cystitis and related antibiotic prescribing patterns.
An estimated 124,978,631 visits among adult women were attributable to cystitis between 1998 and 2009, reported Dr. McGregor of the department of pharmacy practice at Oregon State University, Portland. The mean age of patients for these visits was 50 years, 83% were white, 69% presented to a physician’s office for their cystitis, and 48% had private insurance.
The annual rates of cystitis visits were stable between 1998 and 2009, with an average of 195 visits per 1,000 women. Nearly three-quarters of women (71%) received an antibiotic prescription during the study period.
Prescriptions for the first-line urinary anti-infectives trimethoprim/sulfamethoxazole, trimethoprim, fosfomycin, and nitrofurantoin remained constant (P = .10). But prescriptions for quinolones grew by 10%, and prescriptions for cephalosporins grew by 3%, which were statistically significant increases (P less than .01 and P = .02, respectively).
The findings "correlate with other data showing increasing rates of uropathogen resistance," the researchers wrote. "Further research is needed to evaluate empiric antibiotic prescribing in this setting to ensure prudent antibiotic use and limit the spread of resistance."
The conference was sponsored by the American Society for Microbiology.
Dr. McGregor reported that the National Institutes of Health and the National Center for Research Resources supported the study.