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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.
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, Bactrim, has declined over the past 10 years while the use of second-line drug of choice, the more expensive options are increasing. 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 generic Bactrim is $1.79 whereas the same 10-day course of Cipro, a type of fluoroquinolone, costs $70.98, and a 10-day course of another often-prescribed drug, generic Marcrobid, is $20.34, Huang said.
This trend may be due to doctors adopting a new drug, believing it is the better drug. The finding runs counter to the formal recommendations made by the Infectious Disease Society of America over the past 10 years, which recommends generic Bactrim as a first drug to be used to treat urinary tract infections.
Prescriptions for generic Bactrim 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. However, the implications in terms of cost are substantial, because of the vast difference in the cost of the drugs.
Archives of Internal Medicine January 14, 2002 162:41-47
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