Prescribing Patterns for Patients with Urolithiasis in Emergency Departments: Comparative Analysis of Local Practice versus Evidence-Based Guidelines (2023)

Seyedamir Tabibzadeh Dezfooli; Shirin Gholipour Choubar; Maedeh Asna Aashari; Hassan Amiri; Reza Mosaddegh; Mohammadreza Yasinzadeh; Alireza Javan

doi:10.5455/JMRR.20251130055318

Abstract
Background:
Kidney stones (urolithiasis) are a common urological emergency requiring symptom management and evidence-based pharmacotherapy. Prescribing practices often deviate from guideline recommendations, potentially contributing to antimicrobial resistance and unnecessary medication exposure.
Objective:
This retrospective, descriptive study evaluated prescribing patterns for renal colic in two Iranian emergency departments (EDs), comparing them with international (AUA, EAU) and regional (Asian) guidelines to identify opportunities for evidence-based optimization.
Method:
This cross-sectional study included 168 patients diagnosed with renal colic at Hazrat Rasul Akram Hospital (primary site) and Firouzgar Hospital during 2023. Data were collected using a standardized checklist capturing demographics, stone characteristics, and medication prescriptions. Descriptive statistical analysis was performed using SPSS version 26.
Results:
Of 168 patients (57.7% male, mean age 37.8 ± 11.2 years), all received analgesics (100%). Antispasmodics were prescribed to 75.6% (primarily tamsulosin, 7%), antibiotics to 66.1% (ciprofloxacin 3.9%, amoxicillin 3.4%), H2 receptor antagonists/proton pump inhibitors (PPIs) to 58.9% (famotidine 5.3% [H2 antagonist], pantoprazole 4.8% [PPI]), and urinary alkalinizers to 57.1% (citrate 7.3%). Stone characteristics: predominantly 5–10 mm (85.1%), located in kidney (45.1%), ureter (38.1%), or ureterovesical junction (16.8%).
Conclusion:
While analgesic and antispasmodic prescribing align with guidelines, the high prevalence of antibiotics, H2/PPI use, and urinary alkalinizers exceeds guideline recommendations for acute management. These patterns warrant scrutiny through prospective studies incorporating infection indicators and clinical justification, with targeted interventions to optimize prescribing and reduce unnecessary medication exposure.

Key words: urolithiasis, renal colic, prescribing patterns, antibiotic stewardship, selective prescribing, evidence-based guidelines, urological emergency