Schmiemann and colleagues see important methodological flaws in some aspects of our article (1). We can dispel some of their fears on some points, but for others we could not proceed any differently because of the study design. Baum mentions similar issues. We still think our study is valid.
The representativeness of the sample has been extensively proven (2). We provided a comparative overview of different guidelines. During the study period (2008), representatives from DEGAM were working on the completion of the newest S3 guideline; for this reason the guideline was not included in the overview. As the editorial introducing our article mentioned, our sampling period occurred about two years before the current publication of the S3 guideline on the treatment of uncomplicated urinary tract infections. In regions with resistance rates of below 20% for trimethoprim/co-trimoxazole in E coli, trimethoprim/co-trimoxazole is still the antibiotic of choice (3). The selected antibiotic was entered as free text in our survey. Trimethoprim alone was mentioned only 39 times (0.01%), co-trimoxazole (combination of sulfonamides and trimethoprim) were mentioned 554 times (7%); we combined the results for this reason.
It is known that antibiotic resistance surveillance systems overestimate resistance rates in the outpatient setting. Studies such as the one by Schmiemann are therefore particularly important.
Lindner focuses on the possible influence of sample distribution to doctors by industry representatives. Possible factors of influence from the pharmaceutical industry, such as providing samples, are an important topic. This was discussed in depth during the focus groups preceding our survey (4). Possible influences from the pharmaceutical industry were discussed in our study. These factors did not, however, affect the prescribing of antibiotics in urinary tract infections.
Dr. Edward Velasco, S.M.
Robert Koch-Institut, Berlin
Conflict of interest statement
The author declares 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.||Velasco E, Espelage W, Faber M, Noll I, Ziegelmann A, Krause G, Eckmanns T: A national cross-sectional study on socio-behavioural factors that influence physicians’ decisions to begin antimicrobial therapy. Infection 2011; 39: 289–97. CrossRef MEDLINE|
|3.||Velasco E, Ziegelmann A, Eckmanns T, Krause G: Eliciting views on antibiotic prescribing and resistance among hospital and outpatient care physicians in Berlin, Germany: results of a qualitative study. BMJ Open 2012; 2: e000398 CrossRef MEDLINE PubMed Central|
|4.||Wagenlehner FME, Hoyme U, Kaase M, et al.: Clinical practice guideline: uncomplicated urinary tract infections. Dtsch Arztebl Int 2011; 108(24): 415–23 VOLLTEXT|