Many American Doctors Do Not Follow Practical Guidelines For The Treatment Of Urinary Tract Infections

According to an article published in the January issue of the journal Archives of Internal Medicine, in recent years American physicians have started to prescribe fluoroquinolones for the treatment of uncomplicated urinary tract infections (UTIs) in women, although these drugs are not the drugs of choice The United States with this pathology, as well as their use, is not always economically feasible.

The author, Dr. Elbert S. Huang of the University of Chicago, claims this between 1989 and 1998. The tactics of American physicians regarding UTI therapy have led to increased resistance of microorganisms and economic losses in greater extent than effective treatment results.

In addition, in the past 10 years, the appointment of cotrimoxazole, the drug of choice for the treatment of uncomplicated urinary tract infections in the United States, has declined significantly, but doctors are recommending more expensive alternative drugs, such as fluoroquinolones.

The researchers analyzed data on the appointment of antibiotics to 1,478 women with UTI during the period from 1989 to 1998.

Cotrimoxazole, fluoroquinolones and nitrofurantoin were found to be most commonly prescribed by physicians, but the frequency of cotrimoxazole prescriptions decreased by 49% in 1989-1990. up to 24% in 1997-1998 The frequency of prescriptions for fluoroquinolone, on the other hand, increased from 19% to 29%, respectively, and nitrofurantoin increased from 14% to 30%, respectively.

The study found that prescribing drugs by doctors contradicts the practical recommendations developed by the American Society of Infectious Diseases (IDSA), in which cotrimoxazole was indicated as the initial treatment for uncomplicated acute bacterial cystitis in women if resistance to pathogens in this region is not more than 10-20%.

Researchers note that the appointment of antibiotics depends on the specialty of the doctor, for example, therapists often prescribe fluoroquinolones and obstetricians-gynecologists - nitrofurantoin.

The difference in cost of cotrimoxazole compared to fluoroquinolones and nitrofurantoin remains quite significant. For example, a ten-day course of cotrimoxazole will cost $ 1.79, while the same course of ciprofloxacin will cost $ 70.98 and nitrofurantoin will cost $ 20.34.

In addition to practical recommendations for the use of antibiotics for urinary tract infections, it is also necessary to take into account current data on antibiotic resistance of microorganisms, which are the most common causative agents of urinary tract infections. In the United States, among 10,161 strains of uropathogens causing uncomplicated cystitis, resistance to cotrimoxazole was found in 17.4% of Escherichia coli strains, 17.1% Proteus mirabilis strains, 10.5% Klebsiella pneumoniae and 2.9% - Staphylococcus saprophyticus. Thus, the data obtained indicate that the efficacy of cotrimoxazole may be limited in certain regions of the United States.

Studies on the sensitivity of UTI pathogens in USA show that the prevalence of uropathogenic strains E. coli, resistant to ampicillin and cotrimoxazole, is very high and is respectively 33.3% and 18 , 4%. Modern fluoroquinolones (ciprofloxacin and norfloxacin) are the most active drugs compared to E. coli strains isolated from UTIs. Their resistance is 2.6%. In addition, ciprofloxacin and norfloxacin are active against Escherichia coli strains resistant to nalidixic acid and pipemidic acids. In general, the main problem is the resistance of uropathogens to ampicillin and cotrimoxazole.