Healthy Skepticism Library item: 1652
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Publication type: news
US Docs Opt for Pricey Drugs for Urinary Infection
Reuters Health 2002 Jan 14
Full text:
NEW YORK (Reuters Health) – Only one in four US doctors prescribes the recommended antibiotic for urinary tract infections, with the majority of doctors instead opting for newer and more expensive medications, according to study findings released Sunday.
Such infections are extremely common, particularly in women, and doctors write 2.45 million prescriptions to treat them each year.
``The use of the drug of choice for uncomplicated urinary tract infections, trimethoprim-sulfamethoxazole, has declined over the past 10 years while the use of second-line drug of choice, the more expensive option, fluoroquinolone, is increasing,’‘ Dr. Elbert S. Huang from the University of Chicago, Illinois, told Reuters Health. ``If you consider the number of urinary tract infections that physicians see in a year, that is a substantial difference.’‘
A 10-day course of trimethoprim-sulfamethoxazole is $1.79 whereas the same 10-day course of ciprofloxacin, a type of fluoroquinolone, costs $70.98, and a 10-day course of another often-prescribed drug, generic nitrofurantoin, is $20.34, Huang said.
This trend may be due to doctors adopting a new drug, believing it is the better drug, he added. The finding runs counter to the formal recommendations made by the Infectious Disease Society of America over the past 10 years, which recommends trimethoprim-sulfamethoxazole as a first drug to be used to treat urinary tract infections.
The findings are published in the January 14th issue of the Archives of Internal Medicine.
In the study, Huang and colleagues collected data on nearly 1,500 women with urinary tract infection from a sample of physicians who participated in a survey from 1989 to 1998.
The investigators found that trimethoprim-sulfamethoxazole, fluoroquinolones and nitrofurantoin were the antibiotics most often prescribed. However, prescriptions for trimethoprim-sulfamethoxazole, which is the recommended drug, declined from 49% in 1989 to 1990 to 24% in 1997 to 1998.
In the meantime, prescriptions for fluoroquinolones increased from 19% to 29% and prescriptions for nitrofurantoin increased from 14% to 30%.
There were also differences between the medical specialties in prescribing antibiotics. Internists were most likely to prescribe fluoroquinolones and obstetricians were most likely to prescribe nitrofurantoin, Huang said.
These findings have a minimal clinical impact for women with urinary tract infection, because almost all antibiotics will work, he noted. However, the implications in terms of cost are substantial, because of the vast difference in the cost of the drugs.
SOURCE: Archives of Internal Medicine 2002 January
