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In reply

We appreciate the comments of Dr Johnson. As he notes, recent guidelines suggest that TMP-SMZ should be first-line therapy for urinary tract infection when the prevalence of resistance to this agent is less than 10% to 20%.¹ During our study, the prevalence of TMP-SMZ resistance among outpatient Escherichia coli isolates at our health system was 7%, supporting the choice of TMP-SMZ as first-line therapy for urinary tract infections. In addition to antibiotic allergy history, other potentially mitigating factors were considered in deciding whether fluoroquinolone use was appropriate. These included a review of concurrent medications, recent antimicrobial use, and recent hospitalization. Fluoroquinolone use was considered acceptable if the patient was taking a drug that might interact with TMP-SMZ, received TMP-SMZ within the past month, or was hospitalized within the past 2 weeks. Finally, after further consideration, it may be preferable to categorize fluoroquinolone use as occurring "outside of guidelines" . . . [Full Text of this Article]

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