Kallen Alexander J, Welch H Gilbert, Sirovich Brenda E
VA Outcomes Group, VA Medical Center, White River Junction, VT 05009, USA.
Arch Intern Med. 2006 Mar 27;166(6):635-9. doi: 10.1001/archinte.166.6.635.
Sulfa antibiotics, such as a combination product of trimethoprim and sulfamethoxazole, have traditionally been the drugs of choice for urinary tract infections (UTIs) and remained the most common treatment as recently as a decade ago. However, increasing sulfa resistance among Escherichia coli may have led to changes in prescribing practices.
We used the 2000-2002 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to obtain nationally representative data on antibiotics prescribed for women with isolated outpatient UTIs following visits to physicians' offices, hospital clinics, and emergency departments (n = 2638). Logistic regression was used to determine predictors of quinolone use.
Quinolones were more commonly prescribed than sulfa antibiotics in each year evaluated. In the most recent year of data, quinolones were prescribed in 48% and sulfas in 33% of UTI visits (P<.04). Quinolones were significantly more likely to be prescribed to older patients and in visits occurring in the Northeast; however, no difference in quinolone prescribing was seen when evaluating insurance status, setting, race, ethnicity, health care provider type, and year. Approximately one third of the quinolones used were broader-spectrum agents.
Quinolones have surpassed sulfas as the most common class of antibiotic prescribed for isolated outpatient UTI in women. Few significant predictors of quinolone use exist, suggesting that the increase is not confined to a certain subset of patients. This pervasive growth in quinolone use raises concerns about increases in resistance to this important class of antibiotics.
磺胺类抗生素，如甲氧苄啶和磺胺甲恶唑的复方制剂，传统上一直是治疗尿路感染（UTIs）的首选药物，直到十年前仍是最常用的治疗药物。然而，大肠杆菌对磺胺类药物耐药性的增加可能导致了处方习惯的改变。
我们使用2000 - 2002年全国门诊医疗护理调查和全国医院门诊医疗护理调查，以获取在医生办公室、医院诊所和急诊科就诊后为患有单纯性门诊UTIs的女性开具抗生素的全国代表性数据（n = 2638）。采用逻辑回归分析来确定喹诺酮类药物使用的预测因素。
在每年评估中，喹诺酮类药物的处方比磺胺类抗生素更常见。在最新一年的数据中，48%的UTI就诊处方使用喹诺酮类药物，33%使用磺胺类药物（P <.04）。喹诺酮类药物在老年患者以及东北地区的就诊中开具的可能性显著更高；然而，在评估保险状况、就诊地点、种族、民族、医疗服务提供者类型和年份时，喹诺酮类药物的处方情况没有差异。所使用的喹诺酮类药物中约三分之一是广谱药物。
喹诺酮类药物已超过磺胺类药物，成为女性单纯性门诊UTI最常用的抗生素类别。喹诺酮类药物使用的显著预测因素很少，这表明这种增加并不局限于特定的患者亚组。喹诺酮类药物使用的这种普遍增长引发了对这类重要抗生素耐药性增加的担忧。
