To the Editor.
—The article by Dr Hooton and colleagues1 attempts to standardize therapy for acute cystitis by defining the most efficacious and cost-efficient drug regimen. We agree that the wide variation in clinical practice today clearly indicates the need for this study. However, we disagree with their conclusions.Hooton et al conclude, "A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin....." In their comparative analysis, only nitrofurantoin was statistically inferior to trimethoprim-sulfamethoxazole (P=.04). Cure rates with amoxicillin and with cefadroxil were not statistically different from cure rates with trimethoprim-sulfamethoxazole (P=.11 for both comparisons).The study also failed to account for patients who received care at another clinic and patients who received nonstudy antibiotics. Four patients in the cefadroxil group received nonstudy antibiotics and were excluded. Patients in two of the other groups treated at other clinics
Rieber JM, Goodman RL. Treatment of Acute Cystitis. JAMA. 1995;274(1):25-26. doi:10.1001/jama.1995.03530010039026