I very much welcome the intention and the subject matter of the article by Velasco et al. However, several important issues were not mentioned. In uncomplicated urinary tract infections, resistance rates above 20% may be acceptable if other problems can be avoided.
Trimethoprim is as effective as co-trimoxazole but has far fewer side effects, especially allergy rates. Co-trimoxazole is therefore obsolete for this indication. The product information states that fosfomycin needs to be taken in a precise manner: no food intake two hours before ingestion and one hour afterwards, otherwise the effect may be lost even in susceptible pathogens. Most colleagues are not aware of this and stop using fosfomycin after disappointment with the treatment result.
Nitrofurantoin is licensed in Germany only in cases where alternatives cannot be used or are ineffective.
Most of these points are listed in the guideline published by the German College for General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemein- und Familienmedizin, DEGAM), “Burning Sensation When Passing Water”. The authors of the article have obviously completely ignored this guideline. It is a shame that in conducting the study and preparing the publication, primary care physicians were not included.
Prof. Dr. med Erika Baum
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Schmiemann G, Gebhardt M, Matejczyk M, Hummers-Pradier E: Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin: Leitlinie Nr 1; Brennen beim Wasserlassen – Update 2009; http://leitlinien.degam.de/index.php?id=73.|
|2.||Velasco E, Noll I, Espelage W, Ziegelmann A, Krause G, Eckmanns T: A survey of outpatient antibiotic prescribing for cystitis. Dtsch Arztebl Int 2012; 109(50): 878–84. VOLLTEXT|