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June 20, 1977

Nalidixic Acid-Reply

JAMA. 1977;237(25):2720. doi:10.1001/jama.1977.03270520030013

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In Reply.—  The major purpose of our article was to correct the erroneous impression that full-dosage therapy (4 g/day) with nalidixic acid was associated with an inordinate amount of resistance. This we have done. But if there is any validity between our in vitro antimicrobial resistance studies and in vivo clinical experience, my guess is that there certainly will be a difference in the selection rate of resistant mutants between treatment regimens of 1.5 g and 4.0 g/day; if the resistance rate is only 14% (Dr Bailey notes a cure rate in "excess of 80%") at the 1.5 g dosage rate, this would be twice the rate we observed at 4.0 g/day.We were aware of the work of Crumplin and Smith, but few patients taking full dosages of nalidixic acid will obtain urinary levels of this magnitude. Moreover, the same phenomenon of decreased bacterial sensitivity at higher urinary concentrations