Reducing Ciprofloxacin Prescribing for Acute Uncomplicated Cystitis: A Pilot Study in an Antimicrobial Stewardship Program
Abstract
Material and Methods: A retrospective pre-post intervention study was conducted at Maharaj Nakorn Chiang Mai Hospital. The AMS intervention included the development of hospital-specific empirical treatment guidelines for AUC and bi-monthly educational sessions for general practitioners at outpatient clinics, supported by printed algorithms posted in exam rooms. The pre-intervention period was from March 1, 2021 to August 31, 2021, and the post-intervention period was from October 1, 2021 to March 31, 2022.
Results: Of the 47 enrolled patients, 28 participated in the pre-intervention period and 19 in the post-intervention period. Clinical characteristics were similar between the groups, except for a higher proportion of patients with urinary frequency in the post-intervention period. Antimicrobial appropriateness increased significantly from 0% in the pre-intervention period to 89.5% in the post-intervention period, driven by improvements in appropriate choice (7.1% vs 94.7%), appropriate dose (32.1% vs 94.7%), and appropriate duration (14.3% vs 94.7%). Treatment failure rates were low and did not differ between the 2 periods (7.1% vs. 5.3%).
Conclusion: The appropriateness of antimicrobial treatment improved significantly after the introduction of the AMS, mainly due to the decrease in ciprofloxacin prescribing. Continued AMS efforts in outpatient settings are recommended to maintain appropriate prescribing practices.
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