Optimizing Antibiotic Use for Urinary Tract Infections: A Qualitative Assessment of Regular Prescribing Practices

Abstract

Purpose: Optimizing antibiotic use is essential for overcoming antibiotic resistance. In this study, we identified strategies for improving antibiotic use for urinary tract infections (UTIs). Materials and Methods: This retrospective study was conducted between July 2022 and June 2023 to evaluate the effect of quarterly qualitative assessments of antibiotic prescriptions for inpatients with UTIs. Appropriateness was evaluated based on antibiotic selection, dosage, administration route, and duration, and feedback was shared with medical staff to enhance prescription practices. Evaluations were performed at 3-month intervals, with the first quarter as baseline. Changes in appropriateness were analyzed using linear regression. Results: Overall, 1473 antibiotic prescriptions from 638 patients were analyzed. Third-generation cephalosporins were the most prescribed class. For lower UTIs, significant improvements were observed in treatment duration (40.8%, p=0.050), administration route (22.9%, p=0.039), and dosage (10.5%, p<0.001), thereby increasing the proportion of appropriate prescriptions from 28.6% to 68.0% (p=0.010). For upper UTIs, significant improvements were observed in dosage (6.7%, p=0.032) and duration (20.2%, p=0.032), with the proportion of appropriate prescriptions increasing from 55.9% to 79.0% (p=0.043). Overall, qualitative assessments and feedback improved prescribing appropriateness from 47.1% to 75.5% (p=0.013) without adverse effects on mortality or length of stay. Conclusion: Regular qualitative assessments of antibiotic prescriptions significantly improved prescriptions for UTIs without negative outcomes. These findings support the role of qualitative assessments in antibiotic stewardship; however, further studies are required to evaluate their long-term impact and broader applicability.