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Medical Marketing and Media - Letter to the editor

admin — Mon, 05 Jan 2009 04:11:08 +0000

Another view: how BW beat Roche
May I add a bit of background to an article in the October 2001 issue of MM&M?
I have received and enjoyed MM&M since it was first published. In 1952, I joined the Upjohn sales force and in 1996 1 retired from Roche. I had a delightful career during 40 of the most interesting years in the pharma industry.
This note concerns a comment by William Castagnoli in his article: “Where are they now?” In his summary about the career of BW’s Clifford A. Parrish, there is this claim: “… such successes as the head– to-head introduction and competition of the identical drugs Septra from BW and Roche’s Bactrim, where the smaller BW was able to outperform the formidable Roche marketing machine.” Not to detract one bit from Mr. Parrish’s advertising talents but the truth is that BW was able to outperform Roche in the Septra/Bactrim launch because the Roche Marketing Board assisted them.

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The year of the Septra/Bactrim launch Roche CEO, Irwin Lerner, announced: “Roche has discontinued the sampling of its drugs to U.S. physicians. We hope to set a standard that others in our industry will follow.” As we now know, the industry did not follow Roche’s example. When the BW and Roche reps made their Septra/Bactrim calls, U.S. physicians said: “Great products. Leave your samples and we will remember to use it.” BW loaded in the Septra samples. Roche reps wrung their hands and begged for Bactrim business. My BW competitor at Yale Medical Center, Bill Nawrocki, chuckled: “Is Roche crazy!” Within six months, Roche was back to heavy sampling of Bactrim and all its promoted products. But Septra had this market. Cliff Parrish and the Roche Marketing Board should share the credit for the success of Septra. I think, too, that the Septra/Bacrim launch ended any thought in the minds of pharma marketing executives that drug samples could be discontinued.
Harold F. Mullen
Copyright CPS Communications Dec 2001
Provided by ProQuest Information and Learning Company. All rights Reserved

Chain Drug Review - Sun Pharma

admin — Fri, 02 Jan 2009 05:41:06 +0000

Sun Pharmaceutical Industries Ltd. of India is buying three drug brands from Women’s First Healthcare. The Mumbai-based company is paying $5.4 million (U.S.) for Bactrim, Midrin and Ortho-Est.

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Purchase Bactrim from Best Offshore Online Pharmacy

admin — Mon, 29 Dec 2008 10:26:05 +0000

Bactrim - An Antibiotic Drug For Bacterial Infections
Bactrim, an antibacterial claque soporific, is prescribed for the dine pay the bill format of undoubted urinary area infections, painful medial ear infections in children, elated-long-term or every so often recurring bronchitis in adults that has increased in seriousness, redness of the intestine due to a painful bacterial infection, and travelers’ diarrhea in adults. Purchase Bactrim is also prescribed for the deal with men of Pneumocystis carina pneumonia, and for blocking of this strain of pneumonia in people with weakened vaccinated systems.
Bactrim contains a claque of sulfamethoxazole and trimethoprim and is supplied in tablets and a juice suspension. Sulfamethoxazole and trimethoprim are both antibiotics that dine pay the bill for out of the ordinary strains of infection calando-me-down by bacteria.
Bactrim may also be utilized to handling of:
Infection due to the Bacteria Vibrio Cholera, Typhoid Fever, Infection due to Salmonella paratyphoid Bacteria, lived-appellation Infection with Diarrhea, trouble & preponderance disappointment, Infection due to a Rubella Bacteria, Brain/Spinal string Infection due to Wisteria Monocytogene, Whooping Cough, Bacterial Infection of Blood or Tissues affecting the fit Body.
Most impressive accomplishment connected with Bactrim
Sulfamethoxazole, an ingredient in Bactrim, is one of a platoon of soporifics called sulfonamides, which inhibit the improvement of bacteria in the body. Belittle this medication by enter with an intense window-pane of bedew dilute (8 ounces or 240 milliliters), or as directed by your doctor. If belly screw up occurs, haul with aliment or milk. The bottle abundance of fluids while engaging this medication to baulk unimaginable kidney stones from forming, unless your doctor advises. Dosage is based on your medical requirement and answer to therapy.
Purchase Bactrim works outdo when there is an unswerving amount in the blood. Belittle Bactrim positively as prescribed; try not to evade any doses. It is defeat to survive punishment doses at evenly spaced times day and night.
To truncate the evolution of downer-impenetrable to bacteria and carry on the effectiveness of Bactrim (sulfamethoxazole and trimethoprim) tablets and other antibacterial downers, Bactrim (sulfamethoxazole and trimethoprim) tablets should be old at most to handling of or baulk infections that are proven or strongly suspected to down by bacteria.
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Review of Optometry - Is HIV to Blame for This Retinal Condition?(Brief Article)

admin — Wed, 24 Dec 2008 20:36:03 +0000

A 36-year-old HIV-positive black male presented to the primary-care eye clinic. The primary-care physician at the community health center referred this patient to rule out CMV retinitis. He was first diagnosed with HIV five months prior when he was hospitalized with pneumonia.
The patient’s current list of systemic medications included Viracept (nelfinavir mesylate), Bactrim (trimethoprim and sulfamethoxazole), Combivir (lamivudine and zidovudine), Viramune (nevirapine), ibuprofen and an iron supplement. He did not know his CD4 count or his viral load.

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Buy Bactrim 800 mg Online to Live an Infection Free Life

admin — Fri, 19 Dec 2008 17:56:02 +0000

Bactrim is a combination of two well known antibiotics sulfamethoxazole and trimethoprim. The mixture of these two different antibiotics works synergistically to provide a strong mixture for fighting bacteria. It is a synthetic antibacterial combination product available in DS (double strength) tablets, each containing 800 mg sulfamethoxazole and 160 mg trimethoprim; while in tablets, each containing 400 mg sulfamethoxazole and 80 mg trimethoprim for oral administration. You are supposed to buy bactrim 800 mg online to prevent yourself from infections that may occur by numerous reasons.

Bactrim is used to care for an assortment of infections including a skin condition, urinary tract, and severe middle ear infection in children, long lasting or frequently recurring bronchitis in adults that has increased in seriousness, swelling of the intestine due to a severe bacterial infection, and traveler’s diarrhea in adults. The main advantage of this medication is that it is also prescribed for the treatment of pneumocystis carinii pneumonia, and for prevention of this type of pneumonia in people with weakened immune system. But you are supposed to use this medication as prescribed by physician or according to the instructions of your doctor because without doctors’ prescription the medication can be harmful to your health.

If you are affected by sulfamethoxazole or trimethoprim, then stop taking this medication. In other conditions like kidney or liver illness, a folic acid shortage, asthma or severe allergies, you should not use this medication. Sometimes reactions including severe outbreak around the mouth, anus, or eyes, progressive breakdown of the outer layer of the skin, unexpected and rigorous liver injury, a severe blood disorder and a lack of red blood cell or white blood cell because of bone marrow disorder may be occurred by using it. Although case of reactions are rare. If you are pregnant or want to be pregnant in future then you are supposed to discuss with your doctor before using this medication. It is recommended that the Bactrim antibiotic should be taken with eight ounces of water, and that water is drunk at times all through the rest of the day to avoid painful side-effects.

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Archives of Pathology & Laboratory Medicine - Poorly Differentiated Gastroenteropancreatic Neuroendocrine Carcinoma Associated With X-Linked Hyperimmunoglobulin M Syndrome

admin — Tue, 16 Dec 2008 13:16:02 +0000

Gastroenteropancreatic neuroendocrine tumors are uncommon tumors representing 2% of all gastrointestinal tumors. We report a case of a 21-year-old man with Xlinked hyperimmunoglobulin M (hyper-IgM) syndrome who presented with diarrhea and jaundice. An ultrasound and magnetic resonance imaging showed multiple variable- sized lesions in the liver and peripancreatic lymphadenopathy. The morphologic and immunohistochemical features of the biopsies from the liver and lymph node were consistent with poorly differentiated neuroendocrine carcinoma. Hyper-IgM syndrome is a rare primary immunodeficiency disease characterized by low serum IgG, IgA, and IgE levels with normal or elevated IgM levels. These patients are at a higher risk for developing malignancies, particularly adenocarcinoma of the gastrointestinal tract and lymphoma. A review of the literature of gastroenteropancreatic neuroendocrine tumors is presented with the discussion of a possible relationship of these tumors with immunodeficiency.

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(Arch Pathol Lab Med. 2008;132:847-850)
Neuroendocrine tumors (NETs) arise from the cells of the disseminated neuroendocrine system, which is widely distributed in the body. These are a rare and heterogeneous group of neoplasms characterized by differences in embryologic, biologic, and histopathologic aspects. 1 Gastroenteropancreatic NETs constitute about 2% to 3% of all gastrointestinal malignancies. In 2000, a new World Health Organization classification was established for gastroenteropancreatic NETs. These are now classified according to the classic structural criteria combined with proliferation index (measured by Ki-67) into well-differentiated NETs (proliferation index, 15%), poorly differentiated neuroendocrine carcinoma (>15%), mixed exocrine-endocrine tumors, and tumorlike lesions.
Hyperimmunoglobulin M (hyper-IgM) syndrome encompasses a family of congenital immunodeficiency states characterized by frequent infections and markedly low serum levels of IgG, IgA, and IgE but normal or elevated level of IgM.3 The major defect shared by all forms of the hyper-IgM syndrome is failure of immunoglobulin isotype switching. Mutations affecting at least 5 different genes have been identified to cause this immunodeficiency disorder. 4,5 These genes are involved directly or indirectly in B-cell signaling via CD40 and are required for class switching and somatic hypermutation. The most common form of hyper-IgM syndrome is X-linked and is due to mutation of the CD40 ligand (CD40L) gene.5 Most of these patients present with severe recurrent infections in early childhood. These patients are also at a higher risk for developing malignancies, particularly adenocarcinoma of the gastrointestinal tract and lymphoma.3 In this case study, we describe association of poorly differentiated gastroenteropancreatic neuroendocrine carcinoma in a patient with X-linked immunodeficiency with hyper-IgM (XHIGM).
REPORT OF A CASE
The patient was a 21-year-old man who was diagnosed with XHIGM a few weeks after birth. The patient had been on intravenous IgG and trimethoprim-sulfamethoxazole (Bactrim) prophylaxis since childhood because of his underlying immunodeficiency disorder. The patient was doing fairly well until he presented with diarrhea followed by pruritus, dark urine, and yellow discoloration of the skin and eyes. The jaundice was attributed to cholangitis caused by possible Cryptosporidium infection because of his underlying immunodeficiency state. The patient was put on treatment for presumptive Cryptosporidium infection even though the stool was negative for Cryptosporidium antigen. Laboratory data revealed elevated liver enzymes consistent with cholestasis. Carcinoembryonic antigen and CA 125 levels were within the normal reference range. Computed tomography scan and magnetic resonance imaging of the abdomen revealed multiple moderate-sized hypovascular lesions with rim enhancement in the liver and peripancreatic lymphadenopathy with compression of the common bile duct and uncinate process leading to biliary and pancreatic duct dilatation. A filling defect in the second portion of the duodenum and ampulla of Vater was present. The computed tomography scan and magnetic resonance imaging findings were suspicious for lymphoma or an adenocarcinoma arising from the duodenum or ampulla of Vater. The other findings on limited clinical workup, including chest radiography and bone scan, were within normal limits. Endoscopic-guided fineneedle aspiration biopsies were performed on the liver and peripancreatic lymph nodes.
MATERIALS AND METHODS
The endoscopic-guided fine-needle aspiration smears and biopsies from liver and peripancreatic lymph nodes were available for review. Commercially available antibodies against pan-cytokeratin (1:400; Dako, Carpinteria, Calif), synaptophysin (1:200; Dako), chromogranin (1:100; Dako), CD99 (1:700; Dako), leukocyte common antigen (1:400; Dako), trypsin (1:2000; Dako), chymotrypsin (1:750; Dako), desmin (1:200; Dako), WT-1 (1:100; Dako), and Ki-67 (1:400; Dako) were applied to further characterize the tumors. Immunohistochemical studies were performed on representative deparaffinized slides using an automated slide stainer (Ventana Benchmark, Ventana Medical Systems, Tucson, Ariz).

AIDS Treatment News - Africa: children’s access to prophylaxis may improve after medical study, new WHO recommendations

admin — Sun, 14 Dec 2008 09:26:04 +0000

Note: AIDS Treatment News published this article to provide background for activists who might want to help support the political will to make this long-delayed, lifesaving treatment available to those who need it.
On November 22, 2004, days alter The Lancet reported that the cheap antibiotic co-trimoxazole (Septra, Bactrim, and other brand names) had dramatically reduced death in a group of Zambian children with HIV, the World Health Organization (WHO), UNAIDS and UNICEF released a statement recommending the drug for all children with HIV symptoms in poor countries [1]. But activists say the global health authorities’ seemingly quick action came years–even decades–late, and it will take a lot more work to actually deliver the drug’s lifesaving promise.

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Co-trimoxazole (a combination of trimethoprim and sulfamethoxazole, sometimes called TMP/SMX) was first used to prevent AIDS-related PCP (pneumocystis pneumonia) in 1985 [2]–(although it was standard of care for prevention of PCP in other patients with immune deficiencies long before then). It also prevents toxoplasmosis in people with AIDS [3]. Between 1987 and 1992 (before combination antiretroviral treatment), the drug cut U.S. deaths from PCP by more than half [4]. Yet today, in African countries where very few can get antiretrovirals, co-trimoxazole is still hard to come by, despite its low cost.
“We do not have good estimates of how many children are getting cotrim,” says the WHO’s Dr. Siobhan Crowley, “but our sense from the field is that it is not enough.”
Brook Baker, a Northeastern University law professor and activist with the Health GAP (Global Access Project), says children are particularly neglected, in everything from prevention to prophylaxis to antiretroviral therapy. “Mother-to-child transmission prevention reaches only 10 percent of pregnant women in Africa at best,” he says. “Follow-up for children with antiretrovirals, prophylaxis, or OI medicines is a total mess. Fifty percent of HIV-positive kids die before age 2, and yet drug companies are not investigating pediatric interventions and pediatric formulations.”
Previously, WHO recommended co-trimoxazole for all newborns of women with HIV and to children with low CD4 counts or an AIDS diagnosis [5]. Worried about heavy resistance to the drug in some parts of Africa (where it is used to treat other infections like dysentery and malaria) WHO did not suggest more widespread distribution–such as to children with some symptoms but no access to HIV testing–until now. “Concerns that this would not be effective in areas of high resistance … do not seem to have been shown to be real given this study data,” Crowley says.
Dr. Diana Gibb of the UK’s Medical Research Council and her British and Zambian colleagues conducted the November Lancet study in an area with high bacterial resistance to the medicine. Of children taking co-trimoxazole, 28 percent died, while 42 percent who took placebo died. No allergic reactions occurred. Researchers stopped the trial early so that all children enrolled could get the successful drug [6].
For Baker, the delay in carrying out this research was more than tragic. “Twenty years into the plague, we’re now looking closely at prophylaxis to protect kids,” he says. “It’s outrageous.”
But the wait for widespread access may have just begun. Since 2001, WHO has recommended cotrimoxazole for adults with symptomatic HIV disease or below 500 CD4s, and pregnant women [5]. But the authors of an October Lancet study of co-trimoxazole in Uganda report that the drug is still “rarely used in Africa”–and that Uganda is only now, because of that study, developing a co-trimoxizole policy [6].
Crowley says WHO will “strongly advocate for greater coverage of prophylactic cotrim for both adults and children,” and “ensure governments hear about it.” The drug is cheap–only $10 a year per child–and WHO advises countries to distribute it free [1, 8]. But they will also need training for health care providers, not to mention the desperate scarcity of clinics themselves. David Hoos, MD, who conducts international HIV training, technical assistance and drug procurement programs for Columbia’s Mailman School of Public Health, says that lack of access to antiretrovirals has meant that Africans with HIV aren’t even being brought into regular care where they could get prophylaxis for opportunistic infections.
“People need to come in every month for continuity of care,” he says. “It wasn’t historically a question of [cotrimoxazole] being expensive–the facilities are much more expensive.” Hoos hopes major projects like the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President’s Emergency Plan for AIDS Relief (PEPFAR) will bolster Africa’s health care infrastructure.
UNICEF’s Liza Barrie says her organization will work with WHO and other partners this year to support the following: adaptation of co-trimoxazole treatment guidelines; training; development of new tools to forecast the number of children who will need the drug; and procurement services through UNICEF Supply Division. But it looks like the degree of involvement international agencies pursue might depend on the kind of pressure that is put on them to take action. WHO, UNAIDS and UNICEF, for their part, urge others to act. “Greater advocacy liar the use of co-trimoxazole prophylaxis in children is urgently required,” their statement reads [1].

Causes and Symptoms of Cystitis.

admin — Mon, 08 Dec 2008 08:51:02 +0000

What is Cystitis?
Cystitis is an infection or inflammation of the bladder. The urinary system is composed of the kidneys, ureters, bladder and urethra. All play a role in removing waste from the body. The kidneys help filter waste from your blood. Tubes called ureters carry urine from the kidneys to the bladder, where it is stored until it exits the body through the urethra. A urinary tract infection can begin when bacteria enter the urinary tract through the urethra and then begin to multiply.
Cystitis is rare in men. Women are more prone to the development of cystitis because of their relatively shorter urethra - bacteria do not have to travel as far to enter the bladder - and because of the relatively short distance between the opening of the urethra and the anus.
Causes of Cystitis
More than 85% of cases of cystitis are caused by escherichia coli (”E. coli”), a bacterium found in the lower gastrointestinal tract. Sexual intercourse may increase the risk of cystitis because bacteria can be introduced into the bladder through the urethra during sexual activity. Once bacteria enter the bladder, they are normally removed through urination. When bacteria multiply faster than they are removed by urination, infection results.
Risks for cystitis include:
Obstruction of the bladder or urethra
Insertion of instruments into the urinary tract
Pregnancy
Diabetes
HIV
A history of analgesic nephropathy or reflux nephropathy
Symptoms of Cystitis
Blood in the urine
Stinging or burning when passing urine
Dark (cloudy) or smelly urine
Pain or tenderness in lower back
Low-grade fever
Prevention
Drink plenty of fluids, especially water.
Urinate frequently.
Try to avoid using perfumed soaps, vaginal deodorants, or douches in the genital area.
Try to wear cotton undergarments. Do not wear tight trousers.
Wipe from front to back after going to the bathroom.
Drink cranberry juice to prevent certain types of bacteria from attaching to the wall of the bladder and lessen the chances of infection. **However, don’t drink cranberry juice if you’re taking the blood-thinning medication warfarin (Coumadin). Possible interactions between cranberry juice and warfarin can lead to bleeding.**
Empty your bladder as soon as possible after sex.
Take showers rather than baths.
Treatment
Antibiotics are the first line of treatment for community-acquired bladder infections. Which drugs are used and for how long depend on your health condition and the bacteria found in your urine test, if such a test is performed. The drugs most commonly recommended for simple UTIs include amoxicillin (Amoxil, Trimox), ciprofloxacin (Cipro), nitrofurantoin (Macrodantin, Furadantin), sulfamethoxazole (Bactrim, Septra) and trimethoprim (Trimpex, Proloprim). Make sure your doctor is aware of any other drugs you’re taking or any allergies you might have.
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Full Detailed Information on Middle Ear Infection

admin — Thu, 04 Dec 2008 19:21:03 +0000

Middle ear infection refers to infection of the tiny cavity in the temporal bone that contains three small bones (the malleus, incus, and stapes). Middle ear infection may be acute or chronic, suppurative (pus-producing) or secretory (secretion-producing).

Acute middle ear infection is common in children. Its incidence rises during the winter, when respiratory tract infections are common. With prompt treatment, the prognosis is excellent; however, prolonged fluid buildup in the middle ear causes chronic middle ear infection, with possible puncturing of the eardrum, which transmits sound vibrations to the inner ear.

Chronic suppurative middle ear infection may lead to scarring, adhesions, and severe ear damage. Chronic secretory middle ear infection, with its persistent inflammation and pressure, may cause conductive hearing loss.

What causes it?

Ear infections usually start with a viral infection, such as a cold. The middle ear becomes inflamed from the infection, and fluid builds up behind the eardrum.

Ear infections also can be associated with dysfunction or swelling within the eustachian tubes the narrow passageways that connect the middle ear to the nose. Normally these tubes equalize pressure inside and outside the ear. But a child’s eustachian tubes are narrower and shorter than those of an adult. This makes it easier for fluid to get trapped in the middle ear when the eustachian tubes dysfunction or become blocked during a cold.

What are its symptoms?

* The main symptom is pain in the ear.

* Sometimes the ear drum may burst causing a discharge of fluid from the ear. (Incidentally, this releases the pressure behind the ear drum, and therefore the pain usually disappears.)

* Many children are sick when they have a feverish illness, and so may be sick with middle ear infection.

* There may be some decrease in hearing.

* Occasionally people become a little dizzy.

The whole infection usually only lasts a few days, but there may be persisting deafness for up to a few weeks after the infection.

How is it diagnosed?

The diagnosis can usually be made on the basis of the symptoms and by examining the ear with an otoscope.

Possible complications

* Infections may spread to the bone behind the ear, although this is uncommon.

How is it treated?

Treatment of middle ear infection depends on which type of infection is present.

Treating acute suppurative infection

The doctor prescribes an antibiotic - typically, Totacillin or Amoxil. People who are allergic to penicillin derivatives may receive Ceclor or Bactrim.

Usually, an operation called myringotomy is done to treat severe, painful bulging of the eardrum. In this procedure, the doctor cuts into the eardrum and gently suctions fluid or pus from the middle ear to relieve pressure.

Broad-spectrum antibiotics can help prevent acute suppurative middle ear infection in people at high risk for the disorder. In those with recurring middle ear infection, the doctor will use antibiotics with discretion to prevent development of resistant strains of bacteria.

Treating acute secretory infection

The only required treatment may be inflating the eustachian tube by performing Valsalva’s maneuver several times a day. To perform this maneuver, the person inhales deeply, holds his or her breath, and strains hard before exhaling.

Otherwise, decongestant therapy may help. The person should continue using decongestants for at least 2 weeks and may even need to use them indefinitely, with periodic evaluation. If decongestant therapy fails, the doctor performs myringotomy and removes middle ear fluid, then inserts a polyethylene tube into the eardrum to equalize pressure immediately. The tube falls out spontaneously after 9 to 12 months. At the same time, any underlying cause is treated. For instance, some people must eliminate allergens or have enlarged adenoids removed.

Painkillers - If the ear infection is causing pain then give painkillers to children regularly until the pain eases. For example, paracetamol (Calpol, Disprol, etc) or ibuprofen. These drugs will also lower a raised temperature which can make a child feel better. If antibiotics are prescribed (see below), you should still give the painkiller as well until the pain eases.

Can anything be done to prevent otitis media?

Specific prevention strategies applicable to all infants and children such as immunization against viral respiratory infections or specifically against the bacteria that cause otitis media are not currently available. Nevertheless, it is known that children who are cared for in group settings, as well as children who live with adults who smoke cigarettes, have more ear infections.

American Family Physician - Are physicians adhering to UTI guidelines?

admin — Fri, 28 Nov 2008 19:06:04 +0000

Background: Approximately 7 million patients visit a health care professional in the United States each year for uncomplicated urinary tract infections (UTIs). Most receive prescriptions for trimethoprim/sulfamethoxazole (TMP-SMX [Bactrim, Septra]), ciprofloxacin (Cipro), or nitrofurantoin (Furadantin). Because of potential bacterial resistance to fluoroquinolones and rising medical costs, the Infectious Diseases Society of America (IDSA) published guidelines in 1999 that recommended TMP-SMX as first-line therapy for uncomplicated UTI. In a cross-sectional study, Taur and Smith evaluated whether prescribing habits for UTI changed after the guidelines were published.

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The Study: The authors reviewed data from National Ambulatory Medical Care and National Hospital Ambulatory Care Surveys collected before and after the publication of the guidelines. Using International Classification of Diseases, Ninth Revision, Clinical Modification codes for UTI or acute cystitis, data were analyzed by office site (i.e., private offices or hospital clinics), patient age, patient race, geographic location, prescriber specialty, and patient payment method. Data from emergency department visits were not included.
Results: During the study (1996 to 2001), TMP-SMX and ciprofloxacin were most commonly prescribed, followed by nitrofurantoin. Although TMP-SMX and nitrofurantoin use did not change significantly after the introduction of the guidelines, ciprofloxacin use increased by 66 percent. Similar results were found after controlling for the aforementioned variables. However, hospital-based physicians and generalists were more likely to prescribe TMP-SMX than physicians in private offices; and younger, nonwhite, or self-pay patients were more likely to be prescribed TMP-SMX than ciprofloxacin or nitrofurantoin.
Conclusion: The authors conclude that physicians are not following the IDSA guidelines for treating uncomplicated UTI, which may contribute to rising medical costs and bacterial resistance to fluoroquinolones. These results raise questions about what factors prompt physicians to change their prescribing habits.
AMY CRAWFORD-FAUCHER, MD
Source: Taur Y, Smith MA. Adherence to the Infectious Diseases Society of America guidelines in the treatment of uncomplicated urinary tract infection. Clin Infect Dis March 15, 2007;44:769-74.
EDITOR’S NOTE: This study raises two concerns. First, is the trend away from prescribing TMP-SMX for UTI adversely affecting resistance to antibiotics and medical costs? The study was not designed to address this question, but it would be a logical next research step. Updated and comprehensive information about Escherichia coli resistance to TMP-SMX and ciprofloxacin could help focus this discussion because physicians may base prescribing on perceived or reported rates of resistance in their communities.
The second concern is the apparent non-adherence to the guidelines. An accompanying editorial discusses the study’s inability to determine individual physician exposure to and knowledge of the guidelines and how they were applied in individual cases. (1) Taur and Smith assume that hospital-based clinics, which are more likely to support residency programs, may have physicians who are more comfortable with evidence-based medicine and more up to date with published guidelines than are physicians in private offices. The study highlights the broader issue of disseminating and applying guidelines after they are published.
REFERENCE
(1.) Stamm WE. Evaluating guidelines. Clin Infect Dis 2007;44:775-6.
COPYRIGHT 2007 American Academy of Family Physicians
COPYRIGHT 2008 Gale, Cengage Learning