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Increased Fluoroquinolone Use for Outpatient UTIs

Are fluoroquinolones overused for treatment of urinary tract infections in women?

Urinary tract infection (UTI) is one of the most common indications for outpatient antibiotic therapy. Current guidelines recommend trimethoprim-sulfamethoxazole (TMP-SMX) as first-line treatment unless local rates of resistance among urinary Escherichia coli isolates exceed 15% to 20%. Are TMP-SMX resistance rates prompting inappropriate use of fluoroquinolones (FQs)? Using data for 2000–2002 from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, researchers examined antimicrobial-use patterns for outpatient UTIs in U.S. women.

Of the 1914 UTI visits examined, 75% took place in physician offices, 18% in emergency departments, and 8% in hospital clinics. FQs were the most commonly prescribed antibiotics (44% of visits), followed by sulfa antibiotics (30%) and nitrofurantoin (18%). In addition, FQ use increased during each of the 3 study years (from 38% in 2000 to 48% in 2002). Multivariate analysis revealed that patient age >30 and UTI visit in the Northeast were the only independent predictors of FQ prescription. National antimicrobial resistance surveys cited by the authors demonstrated stable TMP-SMX resistance rates of <20% during the study period; the lowest rates were in the northeastern U.S., where FQ use was highest.

Comment: FQs are replacing sulfa agents as first-line therapy for outpatient UTIs. This dangerous trend, which is likely to lead to increased FQ resistance, seems to be driven by factors other than a realistic assessment of the risks for sulfa resistance and treatment failure. Further study to better define these risks might help persuade clinicians to return to sulfa agents as first-line therapy for outpatient UTIs.

— Daniel J. Diekema, MD, MS

Published in Journal Watch Infectious Diseases April 7, 2006

Citation(s):

Kallen AJ et al. Current antibiotic therapy for isolated urinary tract infections in women. Arch Intern Med 2006 Mar 27; 166:635-9.

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