Quinolone use has surpased Sulfa antibiotics for the treatment of uncomplicated urinary tract infections in women

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Apr 5 2006

Sulfa drugs have traditionally been the most frequently prescribed antibiotics for women with uncomplicated UTIs. However, quinolone use has increased with the emergence of sulfa-resistant E. coli strains, which has been shown to approach 20% in some regions of the country. The exact prevalence of quinolone versus sulfa use remains largely unknown.

In the March 2006 issue of the Archives of Internal Medicine, Kallen and colleagues from the Veterans Administration Medical Center, White River Junction, Vermont, and Dartmouth Medical School present national representative data on antibiotic use for uncomplicated UTIs in women.

National patterns of antibiotic use for UTIs were described for women visiting physicians' offices, hospital clinics, and emergency departments on an outpatient basis (n = 2638). Data were obtained from the National Ambulatory Medical Care Survey (2000-2002) and National Hospital Ambulatory Medical Care Survey.

Quinolone use progressively increased every year up to the most recent year evaluated, being prescribed in 48% of cases compared to 33% with sulfa antibiotics (P < 0.04). Quinolone prescription use was highest among elderly women and with patients in the Northeastern United States. Antibiotic choice did not correlate with insurance status, setting, race, ethnicity, or type of health care provider type.

The question remains: how much is lost from initiating therapy with a sulfa antibiotic and switching to a quinolone in non-responders? Is this practice pattern shift justified? These data raise concerns about the potential emergence of quinolone-resistant strains as their use continues to expand.

By Ricardo F. Sánchez-Ortiz, MD

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