The validity of the study reported by Velasco et al (1) is gravely hampered by methodological shortcomings.
The representativeness of the sample (“physicians providing outpatient care who gave uncomplicated UTI/cystitis as their most common diagnosis”) seems to be questionable, since prescribing statistics show that respiratory tract infections are by far the most common cause for antibiotic prescriptions.
Jointly evaluating the responses from general practitioners and specialists does not make sense since the healthcare setting has a crucial influence on illness severity and treatment. Urologists care for patients with complicated urinary tract infections or infactions caused by problematic pathogens. Therefore urologists require a treatment that differs from the uncomplicated urinary tract infections that are typically dealt with in general practice.
The mono-substance trimethoprim (recommended in the evidence based guideline “Burning Sensation When Passing Water”, by the German College for General Practitioners and Family Physicians [DEGAM]) does not seem to have been mentioned (in response to an open question) by any of the participants. Were the results (2) for trimethoprim (TMP) and trimethoprim-sulfamethoxazole (TMP-SMX) combined? On the basis of recent study results (3) we think that TMP is still the antibiotic of choice. In any case, co-trimoxazole should not be suggested as a suitable alternative.
Current guidelines (DEGAM, AWMF [Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Association of Scientific Medical Societies in Germany]) advise against identifying the pathogen in uncomplicated urinary tract infections. Resistance data, such as the cited German Antibiotic Resistance Surveillance System (ARS) can therefore not offer any insights into the resistance spectrum of uncomplicated infections.
A current comparison with unselected data from primary care (4) shows clear differences to the results from the ARS.
In conclusion, we recommend an analysis of the results presented in the current study for each healthcare setting, respectively.
Dr. med. Guido Schmiemann MPH
Institut für Public Health Universität Bremen
Dr. med. Ildikó Gágyor
Prof. Dr. med. Eva Hummers-Pradier
Institut für Allgemeinmedizin, Universität Göttingen
Dr. med. Jutta Bleidorn
Institut für Allgemeinmedizin
Medizinische Hochschule Hannover
Conflict of interest statement
Dr Schmiemann and Professor Hummers-Pradier are the authors of the DEGAM guideline “Burning Sensation When Passing Water” and were involved on behalf of the DEGAM in the S3 guideline on urinary tract infections.
The other authors declare that no conflict of interest exists.
|1.||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|
|2.||Schmiemann G, Gebhardt K, Matejczyk M, Hummers-Pradier E: Brennen beim Wasserlassen – Anwenderversion der S3 Leitlinie Harnwegsinfekte. Düsseldorf: Omicron publishing; 2009 MEDLINE|
|3.||Kuehlein T, Goetz K, Laux G, Gutscher A, Joos S: Antibiotics in urinary-tract infections. Sustained change in prescribing habits by practice test and self-reflection: a mixed methods before-after study. BMJ Qual Saf 2011; doi: 10.1136/bmjqs.2010.047357 CrossRef MEDLINE|
|4.||Schmiemann G, Gágyor I, Hummers-Pradier E, Bleidorn J: |
Resistance profiles of urinary tract infections in general practice – an observational study. BMC Urology 2012; 12: 33.
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