Many docs over-test and underuse SMX-TMP for UTIs

Many physicians do not adhere to the evidence-based guidelines for the diagnosis and treatment of uncomplicated urinary tract infections (UTIs), according to a report in the February issue of the Mayo Clinic Proceedings.

Michael L. Grover, DO, of the Mayo Clinic College of Medicine in Scottsdale, Ariz., and colleagues reviewed the medical records of female UTI patients seen at their clinic in 2005 to determine if doctors were adhering to guidelines for the diagnosis and treatment of uncomplicated UTIs.

Thirty percent of the 228 patients included in the study had uncomplicated UTIs. Less than 25% of the 68 patients with uncomplicated UTI received treatment based on current guidelines. For example, physicians frequently performed urine culture and sensitivity analyses in patients who already had positive results on a urine dip-stick test. Also, sulfamethoxazole-trimethoprim (SMX-TMP) was underused; only 26 patients (38%) were given the antibiotic as the initial therapy, despite its proven efficacy. Sixty-one percent of prescriptions for SMX-TMP or ciprofloxacin were appropriately filled for 3 days, the report indicates.

Grover ML, Bracamonte JD, Kanodia AK, et al. Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. Mayo Clin Proc. 2007;82:181-185.