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June 20, 1977

Nalidixic Acid

JAMA. 1977;237(25):2720. doi:10.1001/jama.1977.03270520030012

To the Editor.—  I was most interested in the article by Stamey and Bragonje entitled "Resistance to Nalidixic Acid: A Misconception Due to Underdosage" (236:1857, 1976). Like them, I have been impressed by the low development of resistant Enterobacteriaceae in patients having received treatment with nalidixic acid.However, in my experience, the number of side effects suffered by patients taking nalidixic acid in a total dosage of 4 g/day is extremely high.1,2 In addition, there is poor patient compliance when any drug is prescribed in a four-times-daily regimen. In this and other countries, the problem with side effects has been the reason for the relative unpopularity of nalidixic acid, both with medical practitioners and their patients. I have therefore been advising a dosage of 0.5 g three times daily for five days for patients with uncomplicated urinary tract infections.3 The cure rate (sterile urine one week after finishing