Inappropriate use of antibiotics, particularly of vital agents such as fluoroquinolones, is important to recognize and avoid. The recent report by Lautenbach et al1 addressed this need by providing potentially useful data regarding inappropriate use of fluoroquinolones in emergency departments. However, this report leaves uncertainty as to the actual appropriateness of use, particularly with respect to treatment of urinary tract infection, which was the single most common indication for fluoroquinolone therapy in the study. The only stated criterion for appropriate fluoroquinolone use for therapy of urinary tract infection was allergy to the first-line agent, trimethoprim-sulfamethoxazole (TMP-SMZ). However, depending on the local prevalence of resistance to TMP-SMZ among uropathogens in general, or Escherichia coli in particular, alternative therapy (including a fluoroquinolone) actually would be appropriate, according to recent national guidelines.2 It would be of interest to know the relevant resistance prevalence data for the participating centers. Other factors that might favor use of a fluoroquinolone over TMP-SMZ include patient-specific risk factors for a TMP-SMZ–resistant organism3 and potential drug-drug interactions between TMP-SMZ and other medications such as warfarin. The authors' conclusions regarding inappropriateness would be better supported if data were available to show that factors such as these did not make fluoroquinolone use actually appropriate for many of the patients with urinary tract infections.
Johnson JR. Appropriateness of Fluoroquinolones for Therapy of Urinary Tract Infection. Arch Intern Med. 2003;163(13):1616-1617. doi:10.1001/archinte.163.13.1616-a