Drug utilization pattern and physician adherence to treatment guidelines in inpatients with urinary tract infection

Ajitha Sharma, Shweta Oommen


Background: Mainstay of management in urinary tract infection (UTI) is antibiotics and it is seen in recent years that antibiotic resistance is increasing. However, very few treatment guidelines exist for UTI and often treating physicians may not adhere to these guidelines. Aims: Current study was undertaken to analyze antimicrobial prescription pattern and utilization, and check for physician adherence to treatment guidelines in UTI.

Methods: This retrospective, record-based study was carried out in a tertiary care hospital in inpatients with UTI. Tabulated data was analyzed using WHO core drug prescribing indicators and Anatomical Therapeutic Chemical/ Defined Daily Dose (ATC/DDD) index. Adherence to treatment guidelines was assessed using Indian Standard Treatment Guidelines for Urology. Data documented in SPSS software was analyzed using χ2-test and multinomial logistic regression.

Results: Among 364 patients included in study, equal incidence of UTI was seen in both sexes (male to female ratio 1.02:1). Prolonged hospital stay (>7 days) was associated with elderly age group (OR=3.09, CI95% 1.83-5.21), complicated UTI (OR=8.11, CI95% 4.62-14.24), ESBL-producing E. coli (OR=3.07, CI95% 1.58-5.94), non-adherence to treatment guidelines (OR=8.65, CI95% 4.19-17.84), and presence of comorbid conditions like diabetes mellitus (OR=4.89, CI95% 3.05-7.82), benign prostatic hypertrophy (OR=2.76, CI95% 1.36-5.59) and utero-vaginal prolapse (OR=8.33, CI95% 2.28-30.45). Average number of drugs prescribed per encounter was 1.59, while drugs prescribed by generic name and from essential drug list were 98.1% and 70.69% respectively. Majority of prescriptions (87.6%) adhered to standard treatment guidelines. Prescribed daily dose (PDD) and defined daily dose (DDD) were equal for most antibiotics prescribed.

Conclusions: Majority of prescriptions were adhering to treatment guidelines but the need to prescribe using generic name and from essential drug list should be emphasised upon.


Antibiotic, ATC-DDD system, Drug utilization pattern, Escherichia coli, Treatment guidelines adherence, Urinary tract infection

Full Text:



Najar MS, Saldanha CL, Banday KA. Approach to urinary tract infections. Indian J Nephrol. 2009;19(4):129-39.

Sood S, Gupta R. Antibiotic Resistance Pattern of Community Acquired Uropathogens at a Tertiary Care Hospital in Jaipur, Rajasthan. Indian J Community Med. 2012;37(1):39-44.

Prakash D, Saxena RS. Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of Meerut city, India. ISRN Microbiol. 2013;2013:749629.

Truter I. A Review of Drug Utilization Studies and Methodologies. Jordan Journal of Pharmaceutical Sciences. 2008;1(2):91-104.

Sozen H, Gonen I, Sozen A, Kutlucan A, Kalemci S, Sahan M. Application of ATC/DDD methodology to evaluate of antibiotic use in a general hospital in Turkey. Ann Clin Microbiol Antimicrob. 2013;12:23.

Desalegn AA. Assessment of drug use pattern using WHO prescribing indicators at Hawassa University teaching and referral hospital, south Ethiopia: a cross-sectional study. BMC Health Serv Res. 2013;13:170.

Liem TBY, Heerdink ER, Egberts ACG, Rademaker CMA. Quantifying antibiotic use in paediatrics: a proposal for neonatal DDDs. Eur J Clin Microbiol Infect Dis. 2010;29:1301-3.

Ussai S, Rizzo M, Liguori G, Umari P, Pavan N, Trombetta C, et al. Antibiotic Treatment of Urinary Tract Infections (UTIs) In Primary Care: An Italian Pilot Study. J Pharmacovigilance. 2016;4(4):215.

World Health Organization. How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators. Available at: [accessed December 17, 2017].

Standard Treatment Guidelines Urology. Govt. of India: Ministry of Health & Family Welfare 2011. Available at: [accessed December 17, 2017].

Ahmed SM, Jakribettu RP, Koyakutty S, Arya B, Shakir VPA. Urinary tract infections - An overview on the prevalence and the anti-biogram of gram negative uropathogens in a tertiary care centre in North Kerala, India. J Clin Diagn Res. 2012;6(7):1192-5.

George CE, Norman G, Ramana GV, Mukherjee D, Rao T. Treatment of uncomplicated symptomatic urinary tract infections: Resistance patterns and misuse of antibiotics. J Family Med Prim Care. 2015;4(3):416-21.

Dutta SB, Beg MA, Bawa S, Kaur A. Drug utilization study in genitourinary infections used as a teaching tool for rational therapy for MBBS students in a Medical College at Dehradun, Uttarakhand. Int J Basic Clin Pharmacol. 2015;4(2):236-9.

John LJ, Devi P, John J, Guido S. Drug utilization study of antimicrobial agents in medical intensive care unit of a tertiary care hospital. Asian J Pharm Clin Res. 2011;4(2):81-4.

Santra S, Agrawal D, Kumar S, Mishra SS. A Study on the Drug Utilization Pattern in Patients with Chronic Kidney Disease with Emphasis on Antibiotics. J Integr Nephrol Androl. 2015;2(3):85-9.

Aypak C, Altunsoy A, en Duzgun N. Empiric antibiotic therapy in acute uncomplicated urinary tract infections and fluoroquinolone resistance: a prospective observational study. Ann Clin Microbiol Antimicrob. 2009;8:27.

Laupland KB, Ross T, Pitout JD, Church DL, Gregson DB. Community-onset urinary tract infections: a population-based assessment. Infection. 2007;35(3):150-3.

Linhares I, Raposo T, Rodrigues A, Almeida A. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009). BMC Infect Dis. 2013;13:19.

Timothy OO, Olusesan FJ, Adesola BO, Temitayo AA, David FO, Ige OO. Antibiotic resistance pattern of bacterial isolates from cases of urinary tract infections among hospitalized and out-patients at a tertiary health facility in South Western Nigeria. Annals of Tropical Medicine and Public Health 2014;7(2):130-5.

Prakasam AKC, Kumar KGD, Vijayan M. A Cross Sectional Study on Distribution of Urinary Tract Infection and Their Antibiotic Utilisation Pattern In Kerala. Int J Pharm Tech Res. 2012;4(3):1309-16.

National Treatment Guidelines for Antimicrobial Use in Infectious Diseases. National Centre for Disease Control 2016. Available at: [accessed December 17, 2017].

Jan IS, Cheng SH, Hsu HC, Hsueh PR. Physicians’ adherence to guidelines for empirical treatment of urinary tract infection in Taiwan. J Microbiol Immunol Infect. 2007;40:532-6.

Kahan E, Kahan NR, Chinitz DP. Urinary tract infection in women-physician's preferences for treatment and adherence to guidelines: a national drug utilization study in a managed care setting. Eur J Clin Pharmacol. 2003;59(8-9):663-8.

Kahan NR, Chinitz DP, Kahan E. Physician adherence to recommendations for duration of empiric antibiotic treatment for uncomplicated urinary tract infection in women: a national drug utilization analysis. Pharmacoepidemiol Drug Saf. 2004;13(4):239-42.

Bhamare AB, Bhamankar KH, Khairnar AS. Drug Utilization 90% of Urinary Tract Infections Drugs - A Simple Method for Assessing the Quality of Drug Prescribing. Research J Pharm Tech. 2011;4(8):1328-30.

Lautenbach E, Patel JB, Bilker WB, Edelstein PH, Fishman NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis. 2001;32(8):1162-71.

Yang YS, Ku CH, Lin JC, Shang ST, Chiu CH, Yeh KM, et al. Impact of Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae on the outcome of community-onset bacteremic urinary tract infections. J Microbiol Immunol Infect. 2010;43(3):194-9.

Tessema Z, Teshale C, Hawaze S. A retrospective review of antibiotic utilization in adult medical wards of a primary care hospital in Ethiopia. Int J Pharm. 2014;4(1):56-62.

Naik H, Devi A, Sudha MJ. Pattern of Antibiotic prescription in Urinary Tract Infection. Indian Journal of Pharmacy and Pharmacology. 2016;3(2):59-62.

Gidamudi SS, Jadhav SA, Khanwelkar CC, Thorat VM, Desai RR, Naik HG. Drug utilization study on antimicrobial use in urinary tract infection. National Journal of Medical Research. 2015;5(3):216-21.