Cross-Sectional Study Examining the Differences between US Rural and Non-Rural Adults in Appropriate Prescriptions for Nitrofurantoin for the Treatment of Urinary Tract Infections (UTIs) in the ED

Nitrofurantoin is an antibiotic specifically indicated for lower urinary tract infections (UTIs).Rural US populations experience more health care disparities than other groups. Hence, this study sought to answer the question: Are there differences in the appropriate prescribing patterns for nitrofurantoin for the treatment of UTIs in the Emergency Department (ED) between US rural and non-rural adults?. Bivariate and multivariate techniques were used to examine2009 National Hospital Ambulatory Medical Care Survey (NHAMCS) data. The study population was US adults presenting to the ED and given a prescription for nitrofurantoin. Appropriate prescribing was determined by ICD-9 codes consistent with lower UTI diagnoses. Bivariate analysis revealed that rural in comparison to non-rural patients were more likely to be prescribed nitrofurantoin for something other than a UTI (OR = 1.393: 95% CI 1.374-1.412). Logistic regression analysis confirmed that rural patients seen in an ED were less likely to have nitrofurantoin appropriately prescribed. When nitrofurantoin was ordered, inappropriate prescribing occurred in nearly 1 in 4 ED encounters. This can lead to treatment failure and significant toxicities. Pharmacists can play a role in ensuring the proper prescribing of nitrofurantoin as well as other medications.