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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3070 — Antibiotic Utilization: High in Male Veterans with Chronic Prostatitis and Varies by Region and Rate

Author List:
Wilt TJ (Center for Chronic Disease Outcomes Research, Minneapolis, MN)
Taylor B (Center for Chronic Disease Outcomes Research, Minneapolis, MN)
Sohn M (VA Medical Center, Hines, IL)
Cunningham F (VA Pharmacy Benefits and Management Strategic Healthcare Group)

Objectives:
Chronic prostatitis accounts for almost 2 million outpatient visits annually and is characterized by the symptom complex of pelvic area pain and lower urinary tract symptoms. The etiology and optimal management is not known. In the vast majority of men it is believed not to be due to infection and a systematic review of evidence indicated that routine antibiotic use was not indicated. We assessed prevalence of chronic prostatitis and antibiotic utilization among male veterans.

Methods:
VA Inpatient and Outpatient datasets and Pharmacy Benefits and Management files for fiscal year 1999-2003 were merged to assess prostatitis prevalence and antibiotic utilization. Male veteran users with a “primary” or “any” diagnosis of chronic, infectious, or all prostatitis were based on ICD-9 codes. Results were age standardized to fiscal year 2000 and stratified by age, race, and geographic region.

Results:
From 1999 to 2003 the rate of male veteran users with a primary diagnosis of chronic prostatitis declined from 469 to 323/100,000. The highest rates occurred in men aged 55-64. Prostatitis rates were 14-40% higher in Blacks and Hispanics compared with Whites and 2.5 fold higher in Southern than Eastern regions. Unique prescriptions for fluoroquinolone antibiotics were filled in 56% of men with a primary diagnosis of prostatitis. This was 10 fold higher compared to controls of all male VA users of similar age. In men with chronic prostatitis, fluoroquinolone use was higher in Blacks (62%) than Whites (53%). There was a 2 fold difference in fluoroquinolone utilization from low (Eastern) to high utilization regions (Central). Similar patterns in prostatitis patients were observed with other classes of antibiotics including sulfonamides, cephalosporins, penicillins, and tetracyclines. Prescribing patterns were similar in analyses evaluating men with: “prostatitis”; “any diagnosis of chronic prostatitis”, or “infectious prostatitis”.

Implications:
Despite evidence that antibiotics are not effective in chronic prostatitis they were prescribed in over 50% of men with this primary diagnosis. While some use is likely due to comorbid conditions, there was a 10 fold higher rate than similarly aged male veteran controls. Regional and racial variations in utilization suggest that a greater understanding of prescribing patterns is warranted and methods developed to reduce use.

Impacts:
Widespread use of antibiotics in men with chronic prostatitis is unlikely to be effective. Potentially inappropriate use is associated with excess medication costs, treatment related adverse events, and development of resistant organisms.


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