{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T22:40:15Z","timestamp":1788302415832,"version":"build-2803163510"},"reference-count":17,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T00:00:00Z","timestamp":1572480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute uncomplicated cystitis is one of the most common diagnoses for which antibiotic treatment is prescribed in the outpatient setting. Despite the availability of national guidelines, there remains a wide pattern in prescriber choices for therapy. Recent data portray a picture of consistently longer durations than recommended prescribed in outpatient settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The objective was to evaluate the effect of a system-based intervention on adherence to guideline-recommended durations of therapy for uncomplicated cystitis in the outpatient setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This quasi-experimental study included women aged 18\u201364 years who were seen at five family medicine clinics at an academic medical centre and were prescribed targeted antibiotics for uncomplicated cystitis (nitrofurantoin monohydrate\/macrocrystals 100 mg, trimethoprim-sulfamethoxazole 160\/800 mg or ciprofloxacin 250 mg). The intervention involved revising or adding pre-filled, but modifiable, default prescribing instructions in the electronic health record (EHR) for the targeted antibiotics. We evaluated adherence to guideline-recommended duration of therapy as well as days of therapy (DOT) before and after the intervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 787 pre-intervention and 862 post-intervention cases were included. Adherence to recommended duration of therapy increased from 29.4% to 76.3% (P &lt; 0.01). The average DOT decreased by 23% from 6.6 to 5.1 (P &lt; 0.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A stewardship intervention consisting of revising\/adding default prescribing instructions to targeted antimicrobials in an EHR was associated with increased adherence to recommended durations of therapy for uncomplicated cystitis and reduction of unnecessary antibiotic exposure. More studies are needed to confirm effectiveness across multiple medical record platforms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/fampra\/cmz068","type":"journal-article","created":{"date-parts":[[2019,10,2]],"date-time":"2019-10-02T11:18:12Z","timestamp":1570015092000},"source":"Crossref","is-referenced-by-count":2,"title":["Improvement in adherence to antibiotic duration of therapy recommendations for uncomplicated cystitis: a quasi-experimental study"],"prefix":"10.1093","author":[{"given":"Stephanie E","family":"Giancola","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Fort Sam Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M","family":"Higginbotham","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fort Sam Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deena E","family":"Sutter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Fort Sam Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven E","family":"Spencer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Fort Sam Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K","family":"Aden","sequence":"additional","affiliation":[{"name":"Department of Graduate Medical Education, Fort Sam Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice E","family":"Barsoumian","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,31]]},"reference":[{"key":"2019103113193504200_CIT0001","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1093\/cid\/ciq257","article-title":"International clinical practice guidelines for 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acute cystitis in primary care","volume":"2","author":"Grigoryan","year":"2015","journal-title":"Open Forum Infect Dis"},{"issue":"9","key":"2019103113193504200_CIT0007","doi-asserted-by":"crossref","first-page":"ofy198","DOI":"10.1093\/ofid\/ofy198","article-title":"An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections","volume":"5","author":"Durkin","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"2019103113193504200_CIT0008","doi-asserted-by":"crossref","first-page":"e87899","DOI":"10.1371\/journal.pone.0087899","article-title":"Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting","volume":"9","author":"Hecker","year":"2014","journal-title":"PLoS One"},{"key":"2019103113193504200_CIT0009","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.ajem.2015.04.067","article-title":"Impact of an antimicrobial 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Med"},{"issue":"4","key":"2019103113193504200_CIT0012","first-page":"469","article-title":"Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial","volume":"170","author":"Vogel","year":"2004","journal-title":"CMAJ"},{"key":"2019103113193504200_CIT0013","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1093\/jac\/dkt129","article-title":"Community-associated Clostridium difficile infection and antibiotics: a meta-analysis","volume":"68","author":"Deshpande","year":"2013","journal-title":"J Antimicrob Chemother"},{"key":"2019103113193504200_CIT0014","doi-asserted-by":"crossref","first-page":"2326","DOI":"10.1128\/AAC.02176-12","article-title":"Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection","volume":"57","author":"Brown","year":"2013","journal-title":"Antimicrob Agents 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