Empiric treatment of uncomplicated UTI in women: Wasting money when more is not better

Natan R. Kahan*, D. P. Chinitz, D. A. Waitman, E. Kahan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Context: Trimethoprim-sulfamethoxazole (TMP-SMX) and nitrofurantoin were until recently the two drugs recommended in clinical guidelines in Israel for empiric treatment of uncomplicated urinary tract infection (UTI) in women. Objectives: The objective of this study is to evaluate the economic impact of physician non-adherence to these recommendations. Design setting and patients: Data were derived from the electronic patient records of the Leumit Health Fund. Cases of women aged 18 to 75 with a diagnosis of acute cystitis or UTI that were empirically treated with antibiotics from January 2001 to June 2002 were identified. The final sample comprised 7738 physician-patient encounters. The proportion of cases treated with each individual drug was calculated, and the excess expenditure because of non-adherence to guidelines from the perspective of the Health Maintenance Organization (HMO) was evaluated using 5 days of therapy with nitrofurantoin as the reference treatment. Results: TMP-SMX was the most frequently prescribed drug (25-81%), followed by nitrofurantoin (14-71%) representing a 40-52% rate of adherence to the guidelines. Drugs from the fluoroquinolone family were prescribed in 22-82% of cases. Cost of treatment in approximately 70% of the cases exceeded the expected cost of the guideline therapy. Conclusions: Suboptimal adherence to the guidelines resulted in a significant and avoidable waste of the health plan's resources in both drugs and money.

Original languageEnglish
Pages (from-to)437-441
Number of pages5
JournalJournal of Clinical Pharmacy and Therapeutics
Issue number5
StatePublished - Oct 2004


  • Drug utilization
  • Electronic patient records
  • Empiric antibiotic treatment
  • Guidelines
  • Pharmacoeconomics
  • Uncomplicated urinary tract infection

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