ASSESSING THE CLINICAL UTILITY OF ANTIBIOTICS FOR URINARY TRACT INFECTIONS IN INDIA: FINDINGS FROM A QUESTIONNAIRE SURVEY
Narmada Gupta1, Percy Chibber2, Umesh Oza 3, Anant Kumar4, D Ramesh5, Sanjay Pandey6, Mallikarjuna Reddy7, Bibash Kundu 8, Rajesh Taneja9, Ganesh Kamath10 1Medanta, The Medicity, Gurgaon, India2Sir H. N. Reliance Foundation Hospital, Mumbai, India3P.D.Hinduja Hospital, Mumbai, India4Max Hospital, Delhi, India5M.S.Ramaiah Hospital, Bangalore, India6Kokilaben Hospital, Mumbai, India7Citizens Speciality Hospital, Hyderabad, India8Calcutta Medical Research Institute, Kolkata, India9Apollo Hospital, Delhi, India10Sundaram Medical Foundation, Chennai, India
Abstract
Introduction
Develop antibiotic therapy consensus for UTI based on evidence and clinician experiences
Methods
We developed customised technological response system for mapping exercise and panel of eminent specialists was convened. Prior consent was obtained, and the weblink of the questionnaire was provided. Sub-expert nationwide panel (n=397), across India (PRISM Survey group), rated their level of agreement for 11 questions with each item on a 5-point Likert scale and 5 objective response questions. Consensus was pre-defined if weighted mean score for the Likert scale > 100.
Results
The mean years of experience were 9.2 years (SD ±10, 95% CI 8.2-10), and cumulative clinical experience was 3669 man-years. The predominant clinical practice setting of the respondents was a public hospital (58.6%). The highest agreement score in the decreasing rank order (of adjusted weighted mean score) for UTI were; antibiotic resistance is a major challenge (126.1), oral fosfomycin-based regimens are effective against multi-drug resistant pathogens (123.4), is a good option for bacterial biofilm reduction (121.7), the potential to manage recurrent lower UTI (121.6), oral fosfomycin along with nitrofurantoin is been useful to manage MDR UTI (106.8), nitrofurantoin and fosfomycin are chosen as empiric treatment (103.7), fosfomycin has stood the test of time (120.2) (Figure). Adjusted mean response scores (±SD, 95% CI) for consensus were, agree (73±9.4, 95% CI 66 to 79) followed by strongly agree (32±13, 95% CI 24 to 41), neither agree nor disagree (13±4.9, 95% CI 9.8 to 16), disagree (-6.5±4.7, 95% CI -9.7 to -3.4), strongly disagree (-0.86±0.9, 95% CI -1.5 to -0.26)
Conclusions
In the era of MDR UTI time tested oral fosfomycin and nitrofurantoin can improve management of UTI without increasing the complexity
Biography
Dr. N.P. Gupta joined as Chairman, Academics and Research Division Urology in year 2010. During his distinguished career of 45 years in the field of Urology. He has performed more than 30,000 operations for various urological diseases. He is a pioneer and renowned surgeon who started robotic surgery in Urology in 2006 at AIIMS and today has performed the largest number of robotic surgeries in India in his specialty. He was National Delegate and Board Member of Socitete Internationale D’ Urologie (2004-06). He has received several National and International Awards namely, Padamshree by Government of India (2007), Dr. B. C. Roy National Award by Medical Council of India (2005).