BACKGROUND Urinary tract infections (UTI) are among the most common cause to prescribe antibiotics in primary care. Diagnosis is based on the presence of clinical symptoms in combination with the results of laboratory tests. Antibiotic therapy is the primary approach to the treatment of UTIs; however, some studies indicate that therapeutics in UTIs may be suboptimal, potentially leading to therapeutic failure and increased bacterial resistance. METHODS This study aimed to analyze the antibiotic prescription patterns in adult patients with suspected UTIs and to evaluate the appropriateness of the antibiotic prescription. This is a cross-sectional study of patients treated in outpatient centers and in a second-level hospital of the Ministry of Public Health (MOPH) in a city in Ecuador during 2019. The International Classification of Disease Tenth Revision (ICD-10) was used for the selection of the acute UTI cases. The patients included in this study were those treated by family, emergency, and internal medicine physicians. RESULTS We included a total of 507 patients in the analysis and 502 were prescribed antibiotics at first contact, constituting an immediate antibiotic prescription rate of 99.01%. Appropriate criteria for antibiotic prescription were met in 284 patients, representing an appropriate prescription rate of 56.02%. Less than 10% of patients with UTI had a urine culture. The most frequently prescribed antibiotics were alternative antibiotics (also known as second-line antibiotics), such as ciprofloxacin (50.39%) and cephalexin (23.55%). Factors associated with inappropriate antibiotic prescribing for UTIs were physician age over forty years, OR: 2.87 (95% CI, 1.65-5.12) p<0.0001, medical care by a general practitioner, OR: 1.89 (95% CI, 1.20-2.99) p = 0.006, not using point-of-care testing, OR: 1.96 (95% CI, 1.23-3.15) p = 0.005, and care at the first level of health, OR: 15.72 (95% CI, 8.57-30.88) p<0.0001. CONCLUSIONS The results of our study indicate an appropriate prescription rate of 56.02%. Recommended antibiotics such as nitrofurantoin and fosfomycin for UTIs are underutilized. The odds for inappropriate antibiotic prescription were 15.72 times higher at the first level of care compared to the second. Effective strategies are needed to improve the diagnosis and treatment of UTIs.

中文翻译：

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厄瓜多尔疑似尿路感染患者的抗生素处方模式。

背景尿路感染（UTI）是初级保健中开抗生素的最常见原因之一。诊断基于临床症状并结合实验室检查结果。抗生素治疗是治疗尿路感染的主要方法；然而，一些研究表明，尿路感染的治疗可能不是最理想的，可能导致治疗失败和细菌耐药性增加。方法本研究旨在分析疑似尿路感染成年患者的抗生素处方模式，并评估抗生素处方的适当性。这是一项针对 2019 年在厄瓜多尔某城市的门诊中心和公共卫生部 (MOPH) 二级医院接受治疗的患者的横断面研究。国际疾病分类第十次修订版 (ICD-10)用于急性UTI病例的选择。本研究纳入的患者是由家庭医生、急诊医生和内科医生治疗的患者。结果 我们总共纳入了 507 名患者进行分析，其中 502 名患者在首次接触时就被开了抗生素，即刻抗生素处方率为 99.01%。符合抗生素处方合理标准的患者284例，合理处方率为56.02%。不到 10% 的 UTI 患者进行了尿培养。最常用的抗生素是替代抗生素（也称为二线抗生素），例如环丙沙星（50.39%）和头孢氨苄（23.55%）。与尿路感染不适当抗生素处方相关的因素包括医生年龄超过 40 岁，OR：2.87 (95% CI，1.65-5.12) p<0.0001，由全科医生提供的医疗护理，OR：1.89 (95% CI，1.20-2.99) p = 0.006，不使用即时检测，OR：1.96 (95% CI，1.23-3.15) p = 0.005，并且一级健康护理，OR：15.72 (95% CI，8.57-30.88) p<0.0001。结论 我们的研究结果表明适当的处方率为 56.02%。推荐用于治疗尿路感染的呋喃妥因和磷霉素等抗生素未得到充分利用。与第二级护理相比，第一级护理中抗生素处方不当的几率高出 15.72 倍。需要有效的策略来改善尿路感染的诊断和治疗。