Adherence to the Infectious Diseases Society of America Guidelines in the Treatment of Uncomplicated Urinary Tract Infection

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Abstract
Background. Uncomplicated urinary tract infection (UTI) is one of the most common infections encountered and treated in outpatients. A set of guidelines published in 1999 by the Infectious Diseases Society of America recommends trimethaprim-sulfamethoxazole as first-line therapy. Methods. We undertook a study of cross-sectional data describing the use of ambulatory medical services in the United States by women ⩾18 years of age who had uncomplicated UTI. Data from 1996 to 2001 were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to (1) examine the prescribing practices for the treatment of uncomplicated UTI and (2) determine whether these practices were influenced by the recommendation in the Infectious Diseases Society of America guidelines. The major outcomes measurement was to evaluate whether antibacterial selection was influenced by the Infectious Diseases Society of America guidelines. Data were analyzed by year, treatment in private offices vs. hospital clinics, race, geographic location, the specialty of the prescribing health care provider, and the payment method of the patient. Results. We identified 2339 cases of uncomplicated UTI. Trimethaprim-sulfamethoxazole and ciprofloxacin were the most commonly prescribed drugs. Despite the Infectious Diseases Society of America guidelines, the use of trimethaprim-sulfamethoxazole did not change significantly (odds ratio, 0.89; 95% confidence interval, 0.60–1.30; P = .53), whereas the use of ciprofloxacin increased significantly (odds ratio, 1.75; 95% confidence interval, 1.11–2.75; P ⩽ .016). Similar results were obtained after adjusting for age, geographic region, race, physician specialty, payment method, and whether the visit was by a new or returning patient. Conclusions. Despite the Infectious Diseases Society of America recommendation of trimethaprim-sulfamethoxazole as first-line therapy for uncomplicated UTI, physicians in the United States have not altered their prescribing practices. Adjustment for age, geographic region, race, physician specialty, and payment method confirmed a lack of adherence to this recommendation.