I treat a lot of urinary tract infections. UTIs are a common problem, and as we know bacteria and resistance patterns can change. Keeping up with trends in antibiotic use and resistance isn't easy. We tend to look to our state and hospital epidemiology departments for resistance patterns, and to professional societies for official position statements. Data in my area show that E. coli has become more and more resistant to fluoroquinolone antibiotics such as cipro. We use this information to change our prescribing behavior.
The Infectious Disease Society of America recently released new guidelines that recognize this and other facts. They evaluated data on antibiotic resistance, potential side effects, and efficacy of different regimens and among the new recommendations was the elevation of an old antibiotic back to a top pick.
Nitrofurantoin (Macrobid) was used for years to treat UTIs but fell out of favor as cipro and TMP/SMX (Bactrim) became more popular. A major change in antibiotic pricing over the last few years has also favored newer, broader spectrum antibiotics. Bactrim and cipro are available free at some stores and very cheap at others.
And while the newer antibiotics may be cheap, nitrofurantoin is not. A typical course can cost $30. I tweeted this fact and to my surprise, IDSA took note. Not that they are about to change their guidelines, but the fact that they noted a concern from some blogger in the Midwest is an interesting development.