Differences in the Pattern of Antibiotic Prescription Profile and Recurrence Rate for Possible Urinary Tract Infections in Women With and Without Diabetes

  1. Caroline Schneeberger12,
  2. Ronald P. Stolk, MD, PHD1,
  3. J. Hans DeVries, MD, PHD3,
  4. Peter M. Schneeberger, MD, PHD4,
  5. Ron M. Herings, PHD, FISPE56 and
  6. Suzanne E. Geerlings, MD, PHD2
  1. 1Department of Epidemiology, University Medical Center Groningen, Amsterdam, the Netherlands
  2. 2Division of Tropical Medicine and AIDS, Department of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, the Netherlands
  3. 3Department of Internal Medicine, Academic Medical Centre, Amsterdam, the Netherlands
  4. 4Laboratory of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
  5. 5Pharmo Institute, Nieuwegein, the Netherlands
  6. 6Department of Health Policy and Management, Erasmus Medical Center, Rotterdam, the Netherlands
  1. Corresponding author: Suzanne Geerlings, s.e.geerlings{at}amc.nl

Abstract

OBJECTIVE—Women with diabetes have a high incidence and complication rate of urinary tract infections (UTIs). Our aims were to compare current treatment strategies with respect to recurrence rates in women with diabetes with those without diabetes.

RESEARCH DESIGN AND METHODS—We used a Dutch registration database containing pharmacy dispensing data. A total of 10,366 women with diabetes (17.5% premenopausal) (aged ≤55 years) and 200,258 women without diabetes (68% premenopausal) who received a first course of trimethoprim, nitrofurantoin, fosfomycin, or norfloxacin between January 1999 and January 2006 were included. We compared short (≤5 days) with long (>5 days) prescriptions and norfloxacin with trimethoprim, nitrofurantoin, and fosfomycin. A recurrence was defined as a second prescription for one of the above-mentioned agents or a first with amoxicillin (clavulanic acid), fluoroquinolones, or trimethoprim/sulfamethoxazole between 6 and 30 days after inclusion.

RESULTS—Premenopausal women with diabetes more often received a long (26.5 vs. 19.2%; P < 0.001) treatment with norfloxacin (10.7 vs. 6.2%; P < 0.001) but still had a higher recurrence rate (16.1 vs. 12.2%; P = 0.003) compared with those without diabetes. Similarly, postmenopausal women with diabetes more often received a longer (32.8 vs. 28.8%; P < 0.001) treatment with norfloxacin (15.2 vs. 12.7%; P < 0.001) but had a higher recurrence rate (19.1 vs. 16.4%; P < 0.001) compared with those without diabetes.

CONCLUSIONS—Despite the fact that patients with diabetes more often received longer and more potent initial treatment than patients without diabetes, pre- and postmenopausal women with diabetes more often had recurrences of their UTIs.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 24 March 2008.

  • Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted March 19, 2008.
    • Received November 16, 2007.
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  1. Published online before print March 24, 2008, doi: 10.2337/dc07-2188 Diabetes Care July 2008 vol. 31 no. 7 1380-1385
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