Theorie und Praxis der evidenzbasierten Medizin in der Antibiotikaverordnung : unkomplizierte Harnwegsinfektionen bei Frauen

Abstract

The aim of this PhD thesis is to analyze the medical care of adult women in Germany suf-fering from uncomplicated urinary tract infections, as these are the most common bacterial infections encountered in ambulatory care settings. Acute uncomplicated cystitis is one of the most common indications for prescribing of an-timicrobials to otherwise healthy community-dwelling women. Antimicrobial use, whether appropriate or inappropriate, leads to a continuing increase in antimicrobial resistance. The use of administrative data from statutory health insurance funds offers great opportu-nities to assess information about the antibiotic prescribing and it may allow concordance with prescribing guidelines to be assessed. First, computerized literature searches and a review of international MEDLINE-published literature concerning uncomplicated urinary tract infections and antimicrobial resistance in uropathogens have been conducted. Second, epidemiological data were collected as a basis for the following analyses. Based on diagnosis claims data 7,3 % of the BARMER GEK women population, aged 12 years and older, had at least once an urinary tract infection in the year 2013, 1,7 % had at least once cystitis and 0,16 % had at least once pyelonephritis. Despite published national and international guidelines for the optimal selection of an an-timicrobial agent and the duration of therapy, this study demonstrated a wide variation in prescribing practices. Most patients with urinary tract infection were not treated according to the current guidelines. A broad regional variability in antimicrobial prescribing among the German federal states has been manifested, particularly in the prescribing rates of fluoroquinolones. The prescribing rates of fluoroquinolones for cystitis varied 2013 among the different age groups between 27 and 40 %. An optimal approach to therapy must include consideration of antimicrobial resistance and collateral damage such as the selection of drug-resistant organisms and colonization or infection with multidrug-resistant organisms. This could be achieved by evidence based guidelines and a constant monitoring of the antimicrobial prescribing. Informational pro-grams should be initiated to raise the physiciansa awareness of the problem of antimicrobial resistance and improve their guideline adherence.