Proceeding | By Aqtab et. al
Stewardship opportunities in the treatment of urinary tract infection using oral fosfomycin. Much more to be learned
PRESENTED AT | The 10th FIS/HIS conference-UK 2016
Fosfomycin (FM) was first introduced following the fermentation of Streptomyces strain in 1969. Following its unique position for uncomplicated UTI, its appropriate use is of paramount
importance to mitigate the emergence of resistance.
We aim to look at the current practice of prescription in our large outpatient clinic.
This is a retrospective study carried from April 2015 to May 2016 in primary care clinics affiliated to University Malaya Medical Centre, Malaysia. We recruited any patients above 12 years old who received single dose oral FM. We divided the patients into guideline
compliant (GC) and non-guideline compliant (NGC) groups based on available consensus.
100 patients were recruited from a list of 139. The median age was 54.6 (IQR 15–88) and female predominates (81%). 57 of the subjects had at least one co-morbidity and hypertension predominates (40%). There were 91 NGC occurrences. Reasons for NGC were asymptomatic bacteriuria/ABU (18, 19.7%), acute pyelonephritis (13,14.2%), complicated UTI (16, 17.6%) and inappropriate investigations (urine culture (21, 23.1%) and ultrasound of kidney (4, 4.3%)). Urine analysis was the commonest test performed (87, 97%). FMT was prescribed wrongly in 66 subjects (wrong indications).
Discussion and/or Conclusion(s):
The data above illustrates the dire need for education in term of UTI management by the primary care physicians. The misuse of FM was common and not in accordance to the guideline. The additional investigations may be reflective of “non-uncomplicated” nature of UTI. In addition, the lack of susceptibility data on FM against the local contemporary urinary isolates should be addressed.