Dubai Medical Journal · Published 2026-05-22 · DOI 10.18502/dmj.v9i1.21126
Fatima Almeleh, Asma Alzaabi, Maryam Alnuami, Wafa Alayyan, Amna Alsahi, Mohammed Rashid Kayalmadathil
Introduction: Acute uncomplicated cystitis (AUC) is common in primary healthcare settings often treated with antibiotics. However, inappropriate antibiotic use contributes to antimicrobial resistance, costs, and adverse effects. Antimicrobial stewardship (AMS) programs aim to optimize antibiotic use. This study evaluates the impact of AMS compliance on antimicrobial prescription, resistance, and cost, particularly focusing on fluoroquinolone overuse in suspected uncomplicated cystitis patients attending primary health care centers (PHCCs) in Emirates Health Services (EHS). Methods: A cross-sectional study analyzed data from 2043 adult patients (≥18 years) attending AMS-compliant primary health care centers for suspected uncomplicated cystitis between 2019–2022. Data included demographics, diagnoses, prescribed antibiotics, and urine culture results. AMS compliance, antibiotic prescription appropriateness, and trends in antimicrobial resistance and cost were assessed. Results: AMS compliance increased significantly from 55.2% in 2019 to 64.6% in 2022 (p<0.001) and was associated with reduced inappropriate antibiotic prescriptions and increased urine testing rates. Fluoroquinolones were prescribed in 34.2% of cases overall, with Ciprofloxacin being the most common, prescribing peaked in 2021 (38.6%) before declining in 2022 (29.7%). AMS-compliant prescriptions had a significantly lower mean cost compared to non-compliant prescriptions across the study period, with the largest differences observed in 2019 (p=0.002) and 2022 (p<0.001). Escherichia coli (71.5%) and Klebsiella pneumoniae (12.5%) were the predominant urine isolates. Antimicrobial resistance trends were mixed: E. coli showed decreased resistance to fluoroquinolones and several other agents, while K. pneumoniae showed increasing resistance to fluoroquinolones and co-trimoxazole. Discussion: AMS program adherence in PHCCs significantly reduced inappropriate antibiotic prescriptions and fluoroquinolone use for suspected uncomplicated cystitis which led to lower antibiotic costs especially in 2019 and 2022. Observed antimicrobial resistance trends varied with decreases for some antibiotics but increases for others which emphasized the need for continuous AMS implementation and surveillance. Conclusion: Compliance with AMS programs in suspected uncomplicated cystitis cases at PHCCs led to reduced inappropriate antibiotic prescriptions, decreased fluoroquinolone use, and lowered antibiotic costs. Additionally, AMS compliance influenced antimicrobial resistance trends, emphasizing the importance of AMS implementation to mitigate antimicrobial resistance.
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Almeleh, F., Alzaabi, A., Alnuami, M., et al. (2026). Compliance with the Antimicrobial Stewardship Program in Adult Patients Attending Primary Health Care Centers in Emirates Health Services with Suspected Uncomplicated Cystitis and Its Impact on Antimicrobial Prescription and Cost. Dubai Medical Journal. https://doi.org/10.18502/dmj.v9i1.21126