Iskustva žena sa upotrebom antibiotika kod urinarnih infekcija: Uvidi iz perspektive pacijentkinja
Sažetak
Upotreba antibiotika u lečenju infekcija urinarnog trakta (IUT) u Srbiji je nedovoljno istražena, posebno iz ugla pacijenata, te je cilj studije da se ispita upotreba antibiotika kod ovih pacijenata. Sprovedena je onlajn studija preseka tokom zime 2020/21. godine, korišćenjem validiranog Google Docs upitnika i tehnike snežne grudve. Studija je obuhvatila 236 pacijenta ženskog pola, prosečne starosti 34,9 ± 14,2 godina. Većina pacijenata smatrala je simptome ozbiljnim (62,3%), i da simptomi ometaju njihove svakodnevne aktivnosti (51,3%). Većina pacijenata (77,1%) je koristila antibiotike propisane na lekarski recept. Ostali pacijenti su koristili antibiotike samostalno, po sopstvenom izboru. Samolečenje antibioticima je bilo povezano sa percepcijom ozbiljnosti simptoma (p=0,006) i prebivalištem (p=0,017). Pacijenti su prijavili upotrebu 17 različitih antibiotika za lečenje IUT, od kojih su najzastupljeniji bili fluorohinoloni (30,3%), cefalosporini (21,2%) i sulfonamidi (15,7%). Najveća usklađenost primene antibiotika sa nacionalnim i evropskim smernicama uočena je kod trudnica (80,0%). Rezultati istraživanja ističu potrebu za edukacijom zdravstvenih profesionalaca i unapređenju kliničke prakse u donošenju odluka o racionalnom propisivanju antibiotika.
Reference
Belamarić G, Bukumirić Z, Vuković M, Spaho RS, Marković M, Marković G, et al. Knowledge, attitudes, and practices regarding antibiotic use among the population of the Republic of Serbia - A cross-sectional study. J Infect Public Health. 2023;16 Suppl 1:111–8.
Horvat OJ, Tomas AD, Paut Kusturica MM, Savkov AV, Bukumirić DU, Tomić ZS, et al. Is the level of knowledge a predictor of rational antibiotic use in Serbia? PLoS One. 2017;12:e0180799.
Antimicrobial resistance surveillance in Europe 2023–2021 data [Internet]. World Health Organization; 2025 [cited 2025 Mar 19]. Available from: https://www.who.int/europe/publications/i/item/9789289058537.
Little P, Merriman R, Turner S, Rumsby K, Warner G, Lowes JA, et al. Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. BMJ. 2010;340:b5633.
Durkin MJ, Keller M, Butler AM, Kwon JH, Dubberke ER, Miller AC, et al. An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections. Open Forum Infect Dis. 2018;5:ofy198.
Chan AJ, O’Donnell D, Kaasa B, Mathers A, Papaioannou A, Brazil K, et al. Barriers and facilitators of implementing an antimicrobial stewardship intervention for urinary tract infection in a long-term care facility. Can Pharm J (Ott). 2021;154:100–9.
Marchaim D, Gottesman T, Schwartz O, Korem M, Maor Y, Rahav G, et al. National multicenter study of predictors and outcomes of bacteremia upon hospital admission caused by Enterobacteriaceae producing extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 2010;54:5099–104.
Ortega M, Marco F, Soriano A, Almela M, Martínez JA, Muñoz A, et al. Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob Chemother. 2009;63:568–74.
Peña C, Gudiol C, Calatayud L, Tubau F, Domínguez MA, Pujol M, et al. Infections due to Escherichia coli producing extended-spectrum beta-lactamase among hospitalised patients: factors influencing mortality. J Hosp Infect. 2008;68:116–22.
Linsenmeyer K, Strymish J, Gupta K. Two Simple Rules for Improving the Accuracy of Empiric Treatment of Multidrug-Resistant Urinary Tract Infections. Antimicrob Agents Chemother. 2015;59:7593–6.
Bonkat G, Kranz J, Cai T, Geerlings S, Köves B, Pilatz A, et al. European Association of Urology Guidelines on Urological Infections [Internet]. European Association of Urology; 2025 [cited 2025 Mar 19]. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urological-infections-2025_2025-05-24-110339_pxmf.pdf.
Prevention and Treatment of Uncomplicated Urinary Tract Infections: National Guide to Good Clinical Practice. Belgrade: Ministry of Health of the Republic of Serbia, 2022.
Alkhawaldeh R, Abu Farha R, Abu Hammour K, Alefishat E. Optimizing antimicrobial therapy in urinary tract infections: A focus on urine culture and sensitivity testing. Front Pharmacol. 2022;13:1058669.
Frimodt-Møller N, Bjerrum L. Treating urinary tract infections in the era of antibiotic resistance. Expert Rev Anti Infect Ther. 2023;21(12):1301–8.
Jovanović A, Drobac M, Vidović B, Pavlović D, Krajnović D, Tadić I. Herbal products versus antibiotics for urinary tract infections-analysis of patient attitudes. J Herb Med. 2024;46:100892.
Bush K, Courvalin P, Dantas G, Davies J, Eisenstein B, Huovinen P, et al. Tackling antibiotic resistance. Nat Rev Microbiol. 2011;9:894–6.
Scott VCS, Thum LW, Sadun T, Markowitz M, Maliski SL, Ackerman AL, et al. Fear and Frustration among Women with Recurrent Urinary Tract Infections: Findings from Patient Focus Groups. J Urol. 2021;206:688–95.
Yakovlev SV, Suvorova MP. Rationale for choosing an antibiotic for the treatment of cystitis: recommendations of clinical pharmacologists: A review. Ter Arkh. 2022;94:1006–13.
Paterson DL. “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis. 2004;38 Suppl 4:S341–5.
Quinolone- and fluoroquinolone-containing medicinal products [Internet]. European Medicines Agency; 2019 [cited 2025 May 13]. Available from: https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products.
Wu C, Xiao Y, Jing Y, Yin Q, Bao Y. New insights into the solubilization of multicomponent crystals: A case study of pipemidic acid. Cryst Growth Des. 2023;23:3367–83.
Pirrone A, Avantaggiato M, Panzeri F. 5PSQ-002 Prescribing trend of fluoroquinolones following latest EMA recommendations. Eur J Hosp Pharm. 2024;31:A163-A164.
Batista AD, A Rodrigues D, Figueiras A, Zapata-Cachafeiro M, Roque F, Herdeiro MT. Antibiotic Dispensation without a Prescription Worldwide: A Systematic Review. Antibiotics (Basel). 2020;9(11):786.
Asogwa PO, Sarella PNK. Observational studies of prescription pattern and use of antibiotics in selected rural areas. Int J Pharm Sci Med. 2023;8:21–30.
Matin BK, Williamson HJ, Karyani AK, Rezaei S, Soofi M, Soltani S. Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies. BMC Womens Health. 2021;21:44.
Gizaw Z, Astale T, Kassie GM. What improves access to primary healthcare services in rural communities? A systematic review. BMC Prim Care. 2022;23:313.
Bennett AC, Bennett CL, Witherspoon BJ, Knopf KB. An evaluation of reports of ciprofloxacin, levofloxacin, and moxifloxacin-association neuropsychiatric toxicities, long-term disability, and aortic aneurysms/dissections disseminated by the Food and Drug Administration and the European Medicines Agency. Expert Opin Drug Saf.2019;18:1055–63.
DE Nunzio C, Nacchia A, Lombardo R, Franco A, Cicione A, Trucchi A, et al. Is EMA warning on quinolones and fluoroquinolones really assessed? An EudraVigilance database analysis. Minerva Urol Nephrol. 2023;75:374–80.
Hooton TM, Roberts PL, Stapleton AE. Cefpodoxime vs ciprofloxacin for short-course treatment of acute uncomplicated cystitis: a randomized trial. JAMA. 2012;307:583–9.
Hooton TM, Scholes D, Gupta K, Stapleton AE, Roberts PL, Stamm WE. Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. JAMA. 2005;293:949–55.
Butler CC, Francis N, Thomas-Jones E, Llor C, Bongard E, Moore M, et al. Variations in presentation, management, and patient outcomes of urinary tract infection: a prospective four-country primary care observational cohort study. Br J Gen Pract. 2017;67:e830–e841.
Pothoven R. Management of urinary tract infections in the era of antimicrobial resistance. Drug Target Insights.2023;17:126–37.
Zec S, Despotovic A, Spurnic-Radovanovic A, Milosevic I, Jovanovic M, Pelemis M, et al. Antimicrobial resistance in patients with urinary tract infections and the impact on empiric therapy in Serbia. J Infect Dev Ctries.2016;10:1065–72.
Velickovic-Radovanovic RM, Stefanovic NZ, Damnjanovic ID, Petrovic JD, Mitic RV, Kocic BD, et al. The analysis of antibiotic consumption and bacterial resistance in tertiary Healthcare Centre Nis. Hosp Pharmacol - Int Multidiscip.J. 2016;3:341–7.
Lazarević J, Nikolić B, Malešević Z, Ninković V. Antibiotic resistance of causes of urinary tract infections in patients at the Public Health Institute Kragujevac. Zdravstvena zaštita. 2022;51:56–71.
Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ.2017;189:E625–E633.
Yefet E, Schwartz N, Chazan B, Salim R, Romano S, Nachum Z. The safety of quinolones and fluoroquinolones in pregnancy: a meta-analysis. BJOG. 2018;125:1069–76.
- Autori zadržavaju autorska prava i pružaju časopisu pravo prvog objavljivanja rada i licenciraju ga "Creative Commons Attribution licencom" koja omogućava drugima da dele rad, uz uslov navođenja autorstva i izvornog objavljivanja u ovom časopisu.
- Autori mogu izraditi zasebne, ugovorne aranžmane za neekskluzivnu distribuciju članka objavljenog u časopisu (npr. postavljanje u institucionalni repozitorijum ili objavljivanje u knjizi), uz navođenje da je članak izvorno objavljen u ovom časopisu.
- Autorima je dozvoljeno i podstiču se da postave objavljeni članak onlajn (npr. u institucionalni repozitorijum ili na svoju internet stranicu) pre ili tokom postupka prijave rukopisa, s obzirom da takav postupak može voditi produktivnoj razmeni ideja i ranijoj i većoj citiranosti objavljenog članka (Vidi Efekti otvorenog pristupa).
