The appropriateness of empirical antibiotic therapy in the management of symptomatic urinary tract infection patients—a cross-sectional study in Nairobi County, Kenya
Abstract
Background: In low- and- middle income countries, symptomatic urinary tract infection (UTI) patients are often prescribed antibiotics without microbiological confirmation. UTIs caused by antibiotic resistant bacteria are increasingly common and this heightens the risk of empirical treatment failure. This study evaluates the appropriateness of empirical antibiotic therapy to symptomatic UTI patients. Methods: A hospital-based, cross-sectional study was conducted in Nairobi County, Kenya among symptomatic adult and child patients. UTI was defined as a monoculture growth with colony counts of [≥]104. cfu/ml. Antimicrobial susceptibility testing (AST) was performed by the Kirby-Bauer disc diffusion method. Empirical therapy was considered appropriate if the pathogen isolated was susceptible to the prescribed antibiotic and inappropriate if pathogen was resistant to prescribed antibiotic. Results: A total of 552 participants were enrolled with a median age of 29 years (IQR:24-36). The majority were female; 398 (72%). Of the 552, 274 (50%) received empirical antibiotic therapy, 95/274 (35%) were confirmed to have UTI by culture. The antibiotics most frequently prescribed were fluoroquinolones [ciprofloxacin in 80 (30%) and levofloxacin 43 (16%)], amoxicillin-clavulanic-acid in 48 (18%), and nitrofurantoin in 32 (12%). Amongst the 95 patients with bacteriological confirmation of UTI, 50 (53%) received appropriate empirical antibiotic therapy, whilst for 38 (40%) participants, the…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 552 participants or records.
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