Differences in the pattern of antibiotic prescription profile and recurrence rate for possible urinary tract infections (UTI) in women with and without diabetes

Abstract

Background. Women with diabetes mellitus (DM) have a high incidence and complication rate of urinary tract infections (UTI's). Our aims were to compare current treatment strategies with respect to recurrence rates in women with DM compared to those without DM.

Methods. We used a Dutch registration database containing pharmacy dispensing data. A total of 10,366 women with DM (17.5% pre-menopausal <=55 years) and 200,258 women without DM (68% pre-menopausal) who received a first course of trimethoprim, nitrofurantoin, fosfomycin or norfloxacin between January 1999-January 2006 were included. We compared short (<= 5 days) with long (> 5 days) prescriptions and norfloxacin with trimethoprim, nitrofurantoin, 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 (TMP/SMX) between 6 and 30 days after inclusion.

Results. Pre-menopausal women with DM more often received a long (26.5% versus 19.2% P<0.001) treatment with norfloxacin (10.7% versus 6.2% P<0.001), but still had a higher recurrence rate (16.1% versus 12.2% P=0.003) compared to those without DM. Similarly, postmenopausal women with DM more often received a longer (32.8% versus 28.8% P<0.001) treatment with norfloxacin (15.2% versus 12.7% P<0.001), but had a higher recurrence rate (19.1% versus 16.4% P<0.001) compared to those without DM.

Conclusions. Despite the fact that patients with DM more often received initial longer and more potent treatment than patients without DM, pre- and postmenopausal women with DM more often had recurrences of their UTI's.