Antibiotic Use for Genitourinary Infections in an Indonesian Hospital During COVID-19: A Retrospective Study
Main Article Content
Abstract
The management of genitourinary infections presents a growing challenge due to antimicrobial resistance, shifting regional patterns, and evolving etiologies. This study aimed to elucidate antibiotic utilization trends and patterns for genitourinary system diseases at an Indonesian teaching hospital during the COVID-19 pandemic. This retrospective, cross-sectional study analyzed antibiotic use in an Indonesian teaching hospital's inpatient department in 2021. Data on systemic antibiotics (ATC: J01) for genitourinary diseases (ICD-10: N00-N99) were extracted from electronic records. Prescription patterns were evaluated by patient characteristics, disease profiles, administration routes, and WHO AWaRe classification. Among the 47,696 hospitalized patients who received antibiotics, 1,752 were treated with J01 antibiotics for genitourinary disorders, mostly in elderly men with prostatic hyperplasia and obstructive uropathy. Cephalosporins, especially ceftriaxone (724 prescriptions) and cefazolin (294 prescriptions), were the most commonly prescribed, while amoxicillin/beta-lactamase inhibitors were the least prescribed. Parenteral administration was more common than oral, and "Watch" category antibiotics were prescribed twice as often as "Access" antibiotics in adults and the elderly. Genitourinary disorders like prostatic hyperplasia and obstructive uropathy significantly impact elderly men. This study reveals a trend of high broad-spectrum antibiotic use, such as ceftriaxone and cefazolin injections, in hospitalized patients with these conditions.
Article Details

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright and grant the journal the right of first publication simultaneously under the Creative Commons Attribution License. This license allows others to share the work with proper acknowledgment of authorship and initial publication in this journal. Authors are permitted and encouraged to deposit their articles in institutional repositories, on their personal websites, or in other online repositories after the article has been published in JSFK.
References
[1]. Wagenlehner F, Nicolle L, Bartoletti R, Gales AC, Grigoryan L, Huang H, et al. A global perspective on improving patient care in uncomplicated urinary tract infection: expert consensus and practical guidance. Journal of global antimicrobial resistance. 2022;28:18–29. https://doi.org/10.1016/j.jgar.2021.11.008
[2]. Maclaughlin E, Saseen J, Dipiro J, Yee G, Haines S, Nolin T, et al. Pharmacotherapy: A Pathophysiologic Approach. New York: McGraw-Hill Education; 2023.
[3]. Mama M, Mamo A, Usman H, Hussen B, Hussen A, Morka G. Inappropriate antibiotic use among inpatients attending Madda Walabu University Goba Referral Hospital, Southeast Ethiopia: implication for future use. Infection and Drug Resistance. 2020;1403–9. and Drug Resistance, Volume 13, 1403–1409. https://doi.org/10.2147/IDR.S251151
[4]. Morado F, Wong DW. Applying diagnostic stewardship to proactively optimize the management of urinary tract infections. Antibiotics. 2022;11(3):308. https://doi.org/10.3390/antibiotics11030308
[5]. Wilkinson I, Raine T, Wiles K, Hateley P, Kelly D, McGurgan I. Oxford Handbook of Clinical Medicine. Oxford University Press; 2024. 889 p.
[6]. Katzung BG, Trevor AJ. Basic and Clinical Pharmacology. 15th ed. McGraw-Hill Education; 2020.
[7]. Breijyeh Z, Jubeh B, Karaman R. Resistance of gram-negative bacteria to current antibacterial agents and approaches to resolve it. Molecules. 2020;25(6):1340. https://doi.org/10.3390/molecules25061340
[8]. Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA, Braunstein M, Rood JI. Gram-Positive Pathogens. John Wiley & Sons; 2019. 2928 p.
[9]. Jubeh B, Breijyeh Z, Karaman R. Resistance of gram-positive bacteria to current antibacterial agents and overcoming approaches. Molecules. 2020;25(12):2888. https://doi.org/10.3390/molecules25122888
[10]. Roy R. Clinical Practice Recommendations for Pediatric Nephrotic Syndrome. 2024;
[11]. Rahman MM, Alam Tumpa MA, Zehravi M, Sarker MT, Yamin M, Islam MR, et al. An overview of antimicrobial stewardship optimization: the use of antibiotics in humans and animals to prevent resistance. Antibiotics. 2022;11(5):667. Rahman, M. M., Alam Tumpa, M. A., Zehravi, M., Sarker, M. T., Yamin, M. D., Islam, M. R., Harun-Or-Rashid, M., Ahmed, M., Ramproshad, S., & Mondal, B. (2022). An overview of antimicrobial stewardship optimization: The use of antibiotics in humans and animals to prevent resistance. Antibiotics, 11(5), 667. https://doi.org/10.3390/antibiotics11050667
[12]. Susan M. Ford. Roach’s Introductory Clinical Pharmacology [Internet]. 12th ed. 2021 [cited 2024 Nov 19]. Available from: https://www.amazon.com/dp/1496343565?tag=readupnext-20
[13]. WHO W. Antimicrobial resistance [Internet]. 2024 [cited 2024 Oct 22]. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
[14]. 14. Beltran L, Berney DM. The urinary tract and male reproductive system. In: Muir’s Textbook of Pathology. CRC Press; 2020. p. 447–62.
[15]. Schafer EJ, Jemal A, Wiese D, Sung H, Kratzer TB, Islami F, et al. Disparities and trends in genitourinary cancer incidence and mortality in the USA. European Urology. 2023;84(1):117–26. USA. European Urology, 84(1), 117–126. https://doi.org/10.1016/j.eururo.2022.11.023
[16]. Napier-Hemy TP, Liu AKL, Floyd Jr MS, McNulty S, Omar AM, Mistry R, et al. Acute urinary retention in a 27-year-old male secondary to benign prostatic hyperplasia treated with Holmium Enucleation of the Prostate (HOLEP). Urologia Journal. 2023;90(2):426–9. https://doi.org/10.1177/03915603211016613
[17]. Malde S, Umbach R, Wheeler JR, Lytvyn L, Cornu JN, Gacci M, et al. A systematic review of patients’ values, preferences, and expectations for the diagnosis and treatment of male lower urinary tract symptoms. European urology. 2021;79(6):796–809. https://doi.org/10.1016/j.eururo.2020.12.019
[18]. Wijayawardhana H, De Alvis K, Jayawardana A. Juvenile dermatomyositis: Clinical features, evaluation, and management. Preprint] Retrieved from ResearchGate. 2024;
[19]. Kama SC, Obeagu EI, Alo M, Ochei KC, Ezugwu UM, Odo M, et al. Incidence of Urinary Tract Infection among Diabetic Patients in Abakaliki Metropolis. Journal of Pharmaceutical Research International. 2020;32(28):117–21. https://doi.org/10.9734/jpri/2020/v32i2830878
[20]. Ebrahimi P, Karami M, Hosseini-Berneti SH, Lashkarbolouki AH, Keshtegar S, Ghezel MA, et al. Examining the trend of mortality of genitourinary system cancers in Babol, North Iran (2013–2021). BMC urology. 2024;24(1):161. https://doi.org/10.1186/s12894-024-01523-7
[21]. Varda BK, Retik AB. Genitourinary Diseases. In: Hunter’s Tropical Medicine and Emerging Infectious Diseases. Elsevier; 2020. p. 44–51.
[22]. Yu J, Zhou Y, Luo H, Su X, Gan T, Wang J, et al. Mycoplasma genitalium infection in the female reproductive system: Diseases and treatment. Frontiers in Microbiology. 2023;14:1098276. https://doi.org/10.3389/fmicb.2023.1098276
[23]. Romo ML, Moreland SC, Yates AM, Crowell TA, Sevilla M, MacArthur JL, et al. Prevalence of urogenital Mycoplasma genitalium infection at two US Army medical facilities. Sexually Transmitted Diseases. 2024;10–1097. https://doi.org/10.1097/OLQ.0000000000001947
[24]. Riedmeier M, Decarolis B, Haubitz I, Müller S, Uttinger K, Börner K, et al. Adrenocortical carcinoma in childhood: A systematic review. Cancers. 2021;13(21):5266. https://doi.org/10.3390/cancers13215266
[25]. Clay MR, Pinto EM, Fishbein L, Else T, Kiseljak-Vassiliades K. Pathological and genetic stratification for management of adrenocortical carcinoma. The Journal of Clinical Endocrinology & Metabolism. 2022;107(4):1159–69. https://doi.org/10.1210/clinem/dgab866
[26]. Hofman J, Hutny M, Sztuba K, Paprocka J. Corpus callosum agenesis: an insight into the etiology and spectrum of symptoms. Brain sciences. 2020;10(9):625. https://doi.org/10.3390/brainsci10090625
[27]. Nunn AJ. Routes of administration and formulations. In: Paediatric Clinical Pharmacology. CRC Press; 2021. p. 219–33.
[28]. Miles R, Wanklyn S, Ross J. Principles of drug therapy. Oxford Textbook of Palliative Medicine. 2021;364.
[29]. Inayah AF, Nugraha RL, Hasmono D. Postoperative antibiotic therapy patterns in Benign Prostatic Hyperplasia (BPH) patients. In 2021. Available from: https://api.semanticscholar.org/CorpusID:234019276 https://doi.org/10.22219/farmasains.v5i2.13942
[30]. Hari P, Meena J, Kumar M, Sinha A, Thergaonkar RW, Iyengar A, et al. Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux. Pediatric Nephrology. 2024;39(5):1639–68. https://doi.org/10.1007/s00467-023-06173-9
[31]. Lorenzo AJ, Rickard M, Santos JD. The role of bladder function in the pathogenesis and treatment of urinary tract infections in toilet-trained children. Pediatric Nephrology. 2020;35:1395–408. https://doi.org/10.1007/s00467-019-4193-6
[32]. Tramper-Stranders G, Ambrożej D, Arcolaci A, Atanaskovic-Markovic M, Boccabella C, Bonini M, et al. Dangerous liaisons: Bacteria, antimicrobial therapies, and allergic diseases. Allergy. 2021;76(11):3276–91. https://doi.org/10.1111/all.15046
[33]. Moussa M, Abou Chakra M, Dellis A, Moussa Y, Papatsoris A. Pharmacotherapeutic advances for recurrent urinary tract infections in women. Expert Opinion on Pharmacotherapy. 2020;21(16):2011–26. https://doi.org/10.1080/14656566.2020.1795128
[34]. Sher EK, Džidić-Krivić A, Sesar A, Farhat EK, Čeliković A, Beća-Zećo M, et al. Current state and novel outlook on prevention and treatment of rising antibiotic resistance in urinary tract infections. Pharmacology & Therapeutics. 2024;108688. https://doi.org/10.1016/j.pharmthera.2024.108688
[35]. Yassin A, Kaye KS, Bhowmick T. Unitary Tract Infection Treatment: When to Use What Agents including Beta-lactam Combination Agents. Infectious Disease Clinics. 2024;38(2):295–310. https://doi.org/10.1016/j.idc.2024.03.007
[36]. Wombwell E, Rosa A. Comparison of Cefazolin and Ceftriaxone Enterobacterales Susceptibilities for Inpatient Treatment of Urinary Tract Infections and Risk of Hospital-Onset Clostridioides difficile Infection. Clinical Therapeutics. 2024; https://doi.org/10.1016/j.clinthera.2024.02.011
[37]. Katzung BG, Susan B, Antony J. Farmakologi Dasar dan Klinik Edisi 12, Vol. 2. Jakarta: Buku Kedokteran. 2012;
[38]. Slimings C, Riley TV. Antibiotics and healthcare facility-associated Clostridioides difficile infection: systematic review and meta-analysis 2020 update. Journal of Antimicrobial Chemotherapy. 2021;76(7):1676–88. . https://doi.org/10.1016/j.pharmthera.2024.108688
[39]. Arumugham VB, Gujarathi R, Cascella M. Third generation cephalosporins. 2019;
[40]. Bertram Katzung. Katzung & Trevor’s Pharmacology Examination and Board Review [Internet]. 13th ed. 2021 [cited 2024 Nov 19]. Available from: https://www.readupnext.com/book/katzung-trevor-s-pharmacology-examination-and-board-review
[41]. Zhai L, Wang P. Assessing the therapeutic efficacy of Cefoperazone Sodium and Sulbactam Sodium in managing surgical site infections: a retrospective analysis. Scientific Reports. 2024;14(1):27164. https://doi.org/10.1038/s41598-024-77906-5
[42]. Wang TJ, Chang SC, Hsu HH, Huang CS, Lin TR, Lin YP, et al. Efficacy of a self-management program on quality of life in colorectal cancer patients: A randomized controlled trial. European Journal of Oncology Nursing. 2023;67:102431. https://doi.org/10.1016/j.ejon.2023.102431
[43]. Makwana SP, Solanki MN, Dikshit RK. Cefoperazone+ sulbactam versus cefotaxime+ sulbactam combination therapy for the treatment of complicated urinary tract infections in hospitalized patients: Safety and efficacy analysis. Journal of ICT Research & Applications. 2019;9(2). https://doi.org/10.5455/njppp.2019.9.1236526122018