PREVALENCE AND DRUG UTILIZATION PATTERNS OF GENITOURINARY TRACT INFECTIONS IN FEMALES OF REPRODUCTIVE AGE GROUP: A COMPREHENSIVE STUDY

PREVALENCE AND DRUG UTILIZATION PATTERNS OF GENITOURINARY TRACT INFECTIONS IN FEMALES OF REPRODUCTIVE AGE GROUP: A COMPREHENSIVE STUDY

Fariha Fatima *, Fardan Qadeer, Ahmad Raza and Abeer Zubair Khan

Department of Pharmacology, Era’s Lucknow Medical College, Lucknow, Uttar Pradesh, India.

ABSTRACT: Genitourinary tract infections (GUTIs) are a common health concern among females of reproductive age, with significant implications for reproductive and overall health. These infections can lead to complications such as Pelvic Inflammatory diseases, Pyelonephritis and Chronic kidney failure. Furthermore, this leads to poor social and economic impact, particularly in developing nations such as India. The study was conducted to assess the prevalence and drug utilization patterns in the treatment of GUTIs in this population. A cross-sectional analysis was conducted across a diverse cohort of 500 females aged 18-45 years visiting the tertiary care center in Lucknow, Uttar Pradesh, India. Data were collected on the frequency of GUTI symptoms, types of infections, commonly prescribed medications, and adherence to treatment regimens. The results indicate a high prevalence of urinary tract infections (UTIs) and bacterial vaginosis, with significant variability in drug prescription patterns. The results of the study highlighted the concerns regarding antibiotic overuse and resistance. Factors such as age, socioeconomic status, and comorbid conditions were found to influence both infection rates and treatment choices. The findings underscore the need for more targeted public health initiatives and evidence-based guidelines for the management of GUTIs in females of reproductive age.

Keywords: Genitourinary tract infections, Drug utilization, Prevalence, Urinary tract infections, Antibiotic resistance

INTRODUCTION: Genitourinary tract infections (GUTIs) are one of the most prevalent conditions affecting females, with a much higher incidence in reproductive age group ¹. The genitourinary tract encompasses the kidneys, bladder, ureters, and reproductive organs, making it vulnerable to infections due to anatomical, physiological, and hormonal factors.

Women in the reproductive age group (typically defined as ages 18-45) are particularly prone to these infections due to factors such as sexual activity, pregnancy and menstrual hygiene. Urinary tract infections (UTIs) are the most common GUTIs, followed by other infections such as bacterial vaginosis (BV) and pelvic inflammatory disease (PID) ².

These infections can lead to significant morbidity if not appropriately managed, affecting the quality of life, fertility, and increasing the risk of complications like pyelonephritis and septicaemia ³. Early detection and rational treatment protocols are important as they reduce the chances of reoccurrence and drug resistance. The treatment of GUTIs depends on the type of infection, causative organism, patient risk factors, and complications. Uncomplicated GUTIs require short-course empirical antibiotic therapy ⁴. However, treatment approaches for complicated infections are robust and challenging. This study aimed to provide insights into the prevalence of GUTIs in females of reproductive age groups, identify common pathogens involved, and examine drug utilization patterns, focusing particularly on prescription trends, overuse of antibiotics, and potential development of drug resistance.

MATERIALS AND METHODS:

Study Design: A cross-sectional descriptive study was conducted over six months, from January 2024 to June 2024, involving 500 females aged 18-45 years. The participants were recruited from outpatient clinics of a tertiary care teaching hospital of Lucknow. Ethical approval was obtained from the Institutional Review Board (IRB) of the participating institution.

Inclusion and Exclusion Criteria:

Inclusion Criteria: Females aged 18-45 years who presented with symptoms:

• Dysuria (painful urination)
• New nocturia (waking at night to urinate)
• Urinary frequency or urgency
• Suprapubic discomfort
• Fever

Patients presenting with at least two of these symptoms were included for further evaluation

Exclusion Criteria: Pregnant women, females on immunosuppressive therapy, and those on antibiotic therapy for any reason within the last two weeks before the study.

Data Collection: Participants were interviewed using a structured questionnaire that collected demographic details, medical history, presenting symptoms, and the medications prescribed. Urine cultures, vaginal swabs, and other relevant laboratory tests were performed to confirm the diagnosis of UTIs, BV, PID or other GUTIs.

TABLE 1: DIAGNOSTIC CRITERIA FOR GENITOURINARY INFECTIONS

Statistical Analysis: Data were analyzed using descriptive statistics to determine the prevalence of different types of GUTIs and the most commonly used drugs. A chi-square test was used to evaluate associations between demographic factors and infection types, while prescription trends were analyzed using frequency distributions.

RESULTS:

Prevalence of Genitourinary Tract Infections (GUTIs): A total of 500 females who met the symptomatic screening criteria for GUTI infections were screened for laboratory tests. The overall prevalence of GUTIs among females in the reproductive age group was found to be 70% (350). The breakdown of infections is shown in Table 2.

TABLE 2: PREVALENCE OF GENITOURINARY TRACT INFECTIONS (GUTIS)

FIG. 1: PREVALENCE OF GENITOURINARY TRACT INFECTIONS (GUTIS)

Of the 500 females included in the study, 350 (70%) were diagnosed with at least one type of GUTI. The majority, 220 (71.4%), had UTIs, followed by 80 (22.8%) diagnosed with BV. A small subset, 20 (5.7%), were diagnosed with PID and 30 (8.5%) with other genitourinary infections.

Demographic Factors and Infection Types: The age distribution of females with UTIs and BV was examined, as well as the relationship between socioeconomic status (SES) and the prevalence of GUTIs. The findings are summarized in Table 3, Table 4 and Figure 2.

TABLE 3: PREVALENCE OF GUTIS BY AGE GROUP

FIG. 2: PREVALENCE OF GUTIS BY AGE GROUP

TABLE 4: PREVALENCE OF GUTIS BY SOCIOECONOMIC STATUS (SES)

Age distribution showed that women aged 18-30 years had the highest prevalence of UTIs (77%), while those in the 31-45 years group had a higher incidence of BV (40%).

Socioeconomic status (SES) was also found to influence infection rates, with individuals from lower SES groups exhibiting a higher prevalence of UTIs (79%) compared to those from higher SES groups (62%).

Drug Utilization Patterns: The analysis of the most frequently prescribed medications reveals a significant reliance on broad-spectrum antibiotics, as shown in Table 5.

TABLE 5: DRUG UTILIZATION FOR UTI AND BV TREATMENT

A total of 600 prescriptions were analyzed. The most frequently prescribed drugs were:

Antibiotics:

• Nitrofurantoin (40% of prescriptions for UTIs)
• Trimethoprim-sulfamethoxazole (25%)
• Ciprofloxacin (20%)
• Amoxicillin (15%)

Vaginal treatments for BV:

• Metronidazole (60%)
• Clindamycin (32%)
• Secnidazole (8%)

Other treatments for symptomatic relief included analgesics (e.g., paracetamol) and urinary alkalinizing agents (e.g., potassium citrate).

Antibiotic Overuse and Resistance: Antimicrobial resistance testing in non-responders was conducted using Disc Diffusion (Kirby-Bauer method) Resistance patterns for commonly used antibiotics were observed in both UTI and BV cases. The laboratory findings are summarized in Table 6.

TABLE 6: ANTIBIOTIC RESISTANCE IN UTI AND BV CASES

Antibiotic Overuse: An analysis of antibiotic overuse revealed that broad-spectrum antibiotics were frequently prescribed for uncomplicated infections. This is shown in Table 7.

TABLE 7: FREQUENCY OF BROAD-SPECTRUM ANTIBIOTIC USE FOR UNCOMPLICATED UTIS

Antibiotic overuse was observed in the treatment of both UTIs and BV. Approximately 15% of women with uncomplicated UTIs were prescribed broad-spectrum antibiotics (e.g., ciprofloxacin) instead of first-line treatments like nitrofurantoin or trimethoprim-sulfamethoxazole. The study also found that 30% of patients with BV were treated with antibiotics without confirming bacterial aetiology through culture.

Laboratory results from urine cultures and vaginal swabs revealed a growing resistance to commonly used antibiotics, especially in the UTI subgroup. Resistance to nitrofurantoin was present in 12% of UTI cases, while 18% of BV cases exhibited resistance to metronidazole.

DISCUSSION: The present study highlights the increasing burden of genitourinary tract infections (GUTIs) among females of reproductive age and underscores the pressing need for effective, evidence-based management strategies. The high prevalence of empirical antibiotic prescriptions observed in this cohort raises significant concerns regarding antimicrobial resistance (AMR), necessitating the implementation of robust antibiotic stewardship programs to preserve therapeutic efficacy.

Prevalence of GUTIs: Our findings are consistent with the existing literature, which identifies urinary tract infections (UTIs) as the most prevalent GUTI in women of reproductive age, with bacterial vaginosis (BV) following closely in incidence rates ⁶ The higher occurrence of UTIs in younger females may be attributed to multiple risk factors, including increased sexual activity, use of spermicides, hormonal influences, and anatomical susceptibility due to a shorter urethra ⁷.

These factors collectively disrupt the vaginal microflora, predisposing women to recurrent infections.

Drug Utilisation Patterns: The drug utilisation analysis reveals a concerning trend in the empirical use of broad-spectrum antibiotics, particularly fluoroquinolones, for uncomplicated GUTIs. Such prescribing patterns contradict current clinical guidelines, recommending nitrofurantoin or Fosfomycin as first-line agents for uncomplicated UTIs ⁸ Notably, fluoroquinolones should be reserved for complicated cases due to their potential adverse effects and increasing resistance patterns ⁹. Underprescription of nitrofurantoin, despite its narrow spectrum and efficacy, reflects suboptimal adherence to treatment protocols and may contribute to AMR.

Antibiotic Resistance: Antibiotic resistance remains a critical barrier to effective GUTI management. The study observed significant resistance rates to commonly used agents such as nitrofurantoin and metronidazole, highlighting the urgent need for antimicrobial stewardship interventions. These findings align with global surveillance data indicating escalating resistance trends in uropathogens, particularly Escherichia coli and Klebsiella species ^{10, 11}. Culture and sensitivity testing prior to initiating treatment is essential to guide appropriate therapy and reduce the burden of resistant infections ¹².

Challenges and Future Perspectives: Several key challenges were identified in the effective management of GUTIs:

Antimicrobial Resistance (AMR): Misuse and overuse of antibiotics continue to drive resistance. Continuous surveillance of resistance patterns at regional and national levels is critical ¹³.

Self-Medication and OTC Drug Use: A substantial proportion of women resort to self-medication without professional consultation, often leading to inappropriate treatment regimens and poor clinical outcomes ⁹.

Improved Diagnostic Approaches: There is a growing need for rapid diagnostic modalities, including point-of-care testing and molecular diagnostics, to ensure early detection and precise treatment ¹⁴.

Public Health Interventions: Strategies such as public education campaigns, promotion of HPV vaccination, and improved healthcare accessibility can substantially reduce infection rates and disease burden ¹⁵.

CONCLUSION: This study emphasises the high prevalence of GUTIs in females of reproductive age and highlights concerns regarding inappropriate drug utilisation, particularly the overuse of broad-spectrum antibiotics. Improved diagnostic protocols, stricter adherence to evidence-based guidelines, and public health campaigns focused on reducing antibiotic overuse are essential to address the rising concerns of antibiotic resistance. Future studies should focus on long-term outcomes of GUTI treatment and the impact of antimicrobial stewardship programs in reducing resistance patterns.

ACKNOWLEDGMENTS: We sincerely acknowledge Dr. Afroz Abidi, Head, Department of Pharmacology, Era's Lucknow Medical College, for her guidance and support.

CONFLICT OF INTEREST: None.

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    How to cite this article:

    Fatima F, Qadeer F, Raza A and Khan AZ: Prevalence and drug utilization patterns of genitourinary tract infections in females of reproductive age group: a comprehensive study. Int J Pharm Sci & Res 2025; 16(11): 3093-98. doi: 10.13040/IJPSR.0975-8232.16(11).3093-98.

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