Abstract Body

Background

Extensive use of antibiotics and antimicrobial resistance is a major concern globally. In Norway, 82% of antibiotics is prescribed in primary care and one in four prescriptions are issued for the treatment of urinary tract infections (UTI). This study investigated time trends in antibiotic treatment following consultations for UTI in primary care.

Methods

Registry-based study using linked data on all patient consultations for cystitis and pyelonephritis in general practice and out-of-hours (OOH) services, and all dispensed prescriptions of antibiotics in Norway, 2006-2015.

Results

Of the 2,426,643 UTI consultations, 94.5% were for cystitis and 5.5% for pyelonephritis; 79.4 % were conducted in general practice and 20.6% in OOH services. From 2006 to 2015, annual numbers of cystitis and pyelonephritis consultations increased by 33.9% and 14.0%. Proportion of UTI consultations resulting in antibiotic prescription increased gradually for cystitis (36.6% to 65.7%) and pyelonephritis (35.3% to 50.7%). Cystitis was mainly treated with pivmecillinam (53.9%), and trimethoprim (20.8%) and pyelonephritis with pivmecillinam (43.0%), ciprofloxacin (20.5%) and sulfamethoxazole-trimethoprim (16.3%). For cystitis, the use of pivmecillinam increased the most (46.1% to 56.6%), and for pyelonephritis, the use of sulfamethoxazole-trimethoprim (11.4% to 25.5%) and ciprofloxacin (from 18.2% to 23.1%).

Conclusions

During the 10-year study period there was a considerable increase in UTI consultations resulting in antibiotic treatment. Treatment trend for pyelonephritis was characterized by more use of broader-spectrum antibiotics. These trends, indicative of enduring changes in consultation and treatment patterns for UTIs, will have implications for future antibiotic stewardship measures and policy.