Urinary tract infections (UTIs) are one of the most common reasons for prescribing antibiotics in primary care. Diagnosis is based on clinical symptoms and laboratory test results. Although antibiotic therapy is the primary strategy, some studies suggest that treatment may not be optimal, leading to therapeutic failures and bacterial resistance. In the study by Dr. Xavier Sánchez, Dr. Ruth Jimbo-Sotomayor, and Mr. Santiago Escalante, antibiotic prescription patterns in adult patients with suspected UTIs were analyzed, and the appropriateness of these prescriptions was evaluated. A cross-sectional study was conducted in outpatient centers and a second-level hospital of the Ministry of Public Health in a city in Ecuador during 2019. The International Classification of Diseases was used.
Urinary tract infections (UTIs) are the most prominent urological disease in both men and women, representing one of the most common infections in primary care. Approximately half of UTI patients seek treatment in primary care clinics, and a quarter go to emergency services. UTIs can be caused by various organisms, with Escherichia coli being the main responsible agent. Other pathogens include Enterococcus faecalis, Enterobacter spp., Staphylococcus saprophyticus, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas spp.
UTIs manifest clinically with symptoms such as dysuria, frequency, and urgency during urination. About 25% of women experiencing a first episode of UTI suffer recurrences in the following 6 months. Current diagnosis is based on clinical symptoms and laboratory test findings, such as the detection of bacteria in urine using nitrite strips and the semiquantitative evaluation of white blood cell counts in urine. Although urine culture is the conventional method, it is expensive and time-consuming.
Most UTI cases are simple and do not require sophisticated laboratory tests for diagnosis. However, suboptimal diagnostic procedures can lead to excessive or insufficient treatment, with potential serious complications. Overtreatment may result from empirical treatment based solely on symptoms or misinterpretation of diagnostic test results at the point of care. UTIs are the leading cause of antibiotic prescriptions after respiratory tract infections.
Although uncomplicated cases can be empirically treated with antibiotics, there is observed variation in clinical practice. Disparities in the diagnosis and prescription of medications for different diseases could lead to inefficient resource utilization and expose patients to unnecessary risks of adverse events, as well as the risk of antimicrobial resistance. Studies indicate an increase in the prevalence of uropathogens resistant to multiple drugs, attributable in part to unnecessary antibiotic prescriptions and the use of antibiotics that are not recommended.
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