JAC Advance Access published online on January 28, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh100
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Faculty of Pharmacy and
Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta; Faculty of Pharmacy, University
of Manitoba, Winnipeg, Manitoba; Manitoba
Centre for Health Policy, Winnipeg, Manitoba;
* Corresponding author. E-mail: acarrie{at}pharmacy.ualberta.ca.
Received 18 February 2003
; revised 23 November 2003
; accepted 8 December 2003
Objective: To evaluate the effectiveness
of trimethoprim-sulfamethoxazole and fluoroquinolones in
the treatment of community-acquired acute pyelonephritis. Patients and methods: We identified a population-based
cohort of non-pregnant women aged 18-65 years, initially
treated with trimethoprim-sulfamethoxazole or a fluoroquinolone
for community-acquired pyelonephritis in an ambulatory care setting.
Subjects were identified from a healthcare claims database in Manitoba,
Canada for the period 15 February 1996 to 31 March 1999. Subsequent
treatment failure, as evidenced by the provision of additional treatment
up to 42 days post-diagnosis, was compared between the two treatments. Results: A total of 1084 women met inclusion
criteria: 653 (60.2%) treated with trimethoprim-sulfamethoxazole and
431 (39.8%) treated with a fluoroquinolone. Treatment outcomes
were affected by subject age. At age 20, treatment
with a fluoroquinolone resulted in a reduced probability of treatment
failure compared with trimethoprim-sulfamethoxazole (odds
ratio, 0.56; 95% CI, 0.33-0.97). At age 60, there
was no difference in the probability of treatment failure (odds
ratio, 1.61; 95% CI, 0.82-3.16). No other subject
characteristics impacted comparative effectiveness; however, several
characteristics increased the odds of treatment failure irrespective
of the initial antibiotic. These included: recent urinary tract
infection (odds ratio, 2.07; 95% CI, 1.14-3.57),
recent antibiotic use (odds ratio, 1.40; 95% CI, 1.00-1.96;),
and a treatment duration of less than 10 days (odds ratio, 2.18;
95% CI, 1.59-2.99). Conclusion: Younger subjects (
Keywords: outcome assessment (healthcare), health services
research, insurance claim review
Use of administrative healthcare claims to examine
the effectiveness of trimethoprim-sulfamethoxazole versus
fluoroquinolones in the treatment of community-acquired acute pyelonephritis
in women
2 Faculty of Pharmacy, University
of Manitoba, Winnipeg, Manitoba; Manitoba
Centre for Health Policy, Winnipeg, Manitoba;
3 Faculty of Pharmacy, University
of Manitoba, Winnipeg, Manitoba;
4 Department of Medical Microbiology, Faculty of
Medicine University of Manitoba, Winnipeg, Manitoba; Departments of Clinical Microbiology
and Medicine, St. Boniface General Hospital, Winnipeg, Manitoba,
Canada
5 Department of Medical Microbiology, Faculty of
Medicine University of Manitoba, Winnipeg, Manitoba;
20
years) treated with fluoroquinolones were less likely to experience
treatment failure than those treated with trimethoprim-sulfamethoxazole.
Treatment durations of less than 10 days resulted in a higher probability
of treatment failure regardless of the initial antibiotic.
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