Despite guidelines that have been in place for nearly a decade, only 24 percent of the antibiotics prescribed for women's urinary tract infections are the recommended drug, down from 48 percent 10 years earlier. Physicians write 2.45 million such prescriptions each year. The alternative medications are no more effective, encourage the spread of antibiotic resistance, and cost 11 to 40 times as much.
The findings are published in the January 14 issue of the Archives of Internal Medicine.
"We found that from 1989 to 1998 physicians were increasingly likely to manage these common infections in ways that encourage antibiotic resistance and waste money," said Elbert S. Huang, M.D., M.P.H., an instructor of medicine at the University of Chicago and author of the study. "This trend appears to result from non-clinical forces such as pharmaceutical promotions and sub-specialty culture."
Guidelines for the treatment of urinary tract infections (UTI) have not changed significantly since the early 1990s. For example, a well-known 1993 review article and 1999 guidelines from the Infectious Disease Society of America both recommend trimethoprim-sulphamethoxazole (best known as Bactrim) as standard therapy, with certain fluoroquinolones as second-line choices.
Trimethoprim-sulphamethoxazole costs only $1.79 for a ten-day supply. Nitrofurantoin (Macrodantin), prescribed in 30 percent of cases, costs $20.34 for 10 days. Fluoroquinolones, used in 29 percent of cases, can cost as much as $70.98, as in the case of ciprofloxaxin (Cipro).
Huang and colleague Randall Stafford, M.D., Ph.D., of Stanford University, analyzed a representative sample of 1,478 outpatient visits for uncomplicated urinary tract infections over the 1990s. They found that fewer and fewer physicians, and never more than half, followe
Contact: John Easton
University of Chicago Medical Center