Editor's Correspondence |

Adherence to Evidence-Based Therapy: Some Practical Problems—Reply

Elbert S. Huang, MD, MPH; Randall S. Stafford, MD, PhD
Arch Intern Med. 2002;162(11):1310-1311. doi:.
Text Size: A A A
Published online


In reply

We appreciate the comments of Dr Ghosh and agree that following evidence-based guidelines is a complex and often difficult task. In particular, we endorse Dr Ghosh's comments on the need to address both the expectations of patients and the way in which physicians present information on the risks of treatments.

Our article provides the first description of national antibiotic prescribing trends for uncomplicated urinary tract infections in women.1 We found that the first-line recommended antibiotic, trimethoprim-sulfamethoxazole, declined in use over the past decade while less-recommended and more expensive agents, fluoroquinolones and nitrofurantoin, increased dramatically in use during the same period. As suggested by Dr Ghosh, a variety of physician, patient, and health care system–level factors may explain these prescribing patterns. We uncovered differences in antibiotic prescribing between various specialists, suggesting that subspecialty culture plays a role. Similar differences among specialists have been observed previously.2 Further exploration of the reasons for these specialty differences, both qualitative and quantitative, may be a critical next step in understanding antibiotic prescribing patterns. One unique physician-level rationale for prescribing a second- or third-line choice may be a concern for emerging antimicrobial resistance, an issue that exists outside the traditional patient-physician relationship. Ideally, antibiotic recommendations for a community should be based on objective uropathogen resistance trends. Unfortunately, public reports of uropathogen resistance do not appear to be readily available to the clinician, and, when published, are specific to a particular region.3

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles

Users' Guides to the Medical Literature
Clinical Resolution

Users' Guides to the Medical Literature
Clinical Scenario