To the Editor.
—In the recent article on comparative therapies of acute cystitis in women, Dr Hooton and colleagues1 present incomplete data from several fronts.First is the lack of an age distribution of the women included in the study. We were only given their mean age with no upward range.Second, diaphragm use is well documented as being twice as frequent in the nitrofurantoin group compared with the trimethoprim-sulfamethoxazole group. Although the numbers are small, this cannot be discounted. The sexual activity during the study time is not delineated in the study design. Similarly, the study design lacks assurance of compliance. There is no indication that a pill count was completed.Finally, the authors used an older formulation of nitrofurantoin (four times daily) while a newer twice-daily regimen is available, relatively inexpensive, and likely to be met with better compliance.These facts need to be addressed if we
Hellerstein DK. Treatment of Acute Cystitis. JAMA. 1995;274(1):26. doi:10.1001/jama.1995.03530010039027