Appropriateness of the Empirical Antibiotherapy Choices of Primary Care Physicians for the Treatment of Uncomplicated Cystitis

Objective: In primary care, the frequency of inappropriate antibiotic prescriptions for urinary tract infections is very high. In this study, we aimed to evaluate the appropriateness of antibiotic choices of primary care physicians for treating uncomplicated cystitis in adult patients considering relevant guidelines.Methods: The study was conducted with family physicians working in family health centers, general practitioners working as family physicians, and family medicine specialists and assistants working in secondary and tertiary care hospitals in Istanbul between December 2022 and January 2023. Google Forms was used to create a survey for data collection and was distributed to physicians online.Results: The study included 421 physicians. Among the physicians, the rates of fosfomycin, nitrofurantoin, cephalosporin, sulfonamide, fluoroquinolone (FQ), and penicillin choices were determined to be 83.8% (n=353), 52.3% (n=220), 24% (n=101), 14.5% (n=61), 26.6% (n=112), and 10.7% (n=45). Accepting the use of FQ and aminopenicillin as inappropriate in the first-line treatment of uncomplicated cystitis, younger physicians with shorter tenure were more likely to prescribe appropriate empirical antibiotics (p=0.001). In addition, general practitioners working as family physicians applied inappropriate empirical treatment at a significantly higher rate than family medicine specialists and assistants (39.3% vs. 10% and 11.9%, respectively).Conclusion: A significant portion of the primary care physicians who participated in this study were determined to prefer antibiotics not recommended in the relevant guidelines for the empirical treatment of uncomplicated cystitis. The higher rates of inappropriate treatment choices of general practitioners and senior physicians in empirical treatment indicate the need for in-service training in primary healthcare services.