Doctors are less likely today to follow the correct advice for antibiotic prescription than they were ten years ago.

When it comes to treating an infection, all antibiotics are not the same. Besides the obvious consideration of whether the drug kills or controls the microbe involved, the issues of cost and antibiotic resistance are increasingly important. So it's disturbing to learn than on these last two factors, physicians are far from adhering to the official guidelines.

The recommended antibiotic for female urinary tract infection (UTI) is trimethoprim-sulphamethoxazole. According to researchers at the University of Chicago, who analysed 1,478 outpatient visits for UTI in the nineties, in 1989-90, 48 per cent of doctors would prescribe trimethoprim. Ten years on, the figure was only 24 per cent.

What has been happening? Use of two other drugs - fluoroquinolone and nitrofurantoin - has increased, with internal medicine specialists favouring the former, and obstetricians and gynaecologists the latter. There's been more use of ciprofloxacin too. These drugs are undoubtedly effective - but they're not the first line recommended treatment. Their overuse adds millions of dollars to the national drug bill and encourages the emergence of resistant bacteria. Our antibiotic weapons are precious and, more than ever, they need to be used with care or they may lose their power to heal us. Doctors should stick to the guidelines, or give a good reason why they choose not to.

Source

Archives of Internal Medicine January 14 2002