Empirical treatment of acute uncomplicated cystitis in women: drug choice and treatment costs

Introduction: According to the guidelines of The European Association of Urology, the following are considered as first choice drugs in the treatment of acute uncomplicated urinary tract infections (UTIs): fosfomycin trometamol, pivmecillinam and nitrofurantoin. Cotrimoxazole and/or trimethoprim can be considered as drugs of first choice in areas with known E. coli resistance rates of <20%. The aim of the present study was to determine the drug of first choice for the empirical treatment of UTIs in primary health care in our community and to determine the treatment cost differences. Results: Out of 500 medical records of women older than 18 years reviewed in two units of family medicine, 115 (23%) had at least one uncomplicated urinary tract infection in the period January 2010 to May 2013. Empirical treatment for them was chosen based on the official guide (3/7), physician’s own experience (2/7) or a recommendation of a colleague (2/7). UTIs were most commonly treated during 7.3 days with ciprofloxacin (46/115), which is not officially recommended as a first-line drug. This is also longer than the recommended three day course. The annual cost for ciprofloxacin was 2.5 times higher compared to the nitrofurantoin officially recommended as the first choice drug and 3.5 times higher compared to cotrimoxazole which is the second most commonly prescribed drug. Conclusion: It is necessary to increase awareness of the importance of following therapeutic guides, as well as the availability of therapeutic guides in primary medical practice. Key words: Acute uncomplicated urinary tract infections, women, empirical treatment, therapeutic guide