Patterns of antimicrobial prescribing for urinary tract infections and analysis of variations between practices among Croatian GPs

Background
In the outpatient setting, prescribing first-line antibiotics is an ordinarily adopted measure to reduce the spread of antimicrobial resistance of urinary pathogens.

Objectives
We aimed to analyze the antibiotic prescribing for urinary tract infections (UTIs) in a sample of general practitioners (GPs).

Material and methods
A cross-sectional study was conducted on a sample of 42 general practitioners (GPs) between March and October 2019. Prescription data were collected from electronic medical records (EMRs). We analyzed the total prescribing volume and proportions of the first-line antibiotics and fluoroquinolones and compared prescribing patterns with the European Surveillance of Antimicrobial Consumption (ESAC) quality indicators.

Results
Of the 24,117 prescriptions of antibiotics for systemic use (ATC J01), 22% were prescribed for all UTIs in both sexes and 14.8% for uncomplicated lower urinary tract infections (uLUTIs) in women over 18 years of age. Antibiotic prescription rates per 100 patients were 7.9/100 for all UTIs, and 5.3/100 for uLUTIs. Large differences were observed between the highest and lowest prescribing rates/ 100 patients (6 times), unrelated to number of patients on the list. Prescribing rates did not differ significantly concerning GPs´ length of service and specialization in family medicine (FM). Most physicians prescribed outside the recommended ranges according to the ESAC prescribing quality indicators.

Conclusions
Empirical treatment of uLUTIs in a sample of GPs was suboptimal regarding quality criteria. Large individual differences in prescribing practices were unrelated to the number of enlisted patients but probably reflected incorrectly adopted prescribing habits.