We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Nonspecific Guidelines Lead to Inappropriate Fluoroquinolone Use—Reply

Ebbing Lautenbach, MD, MPH; Lori A. Larosa, PharmD; Nishaminy Kasbekar, PharmD; Helen P. Peng, PharmD; Richard J. Maniglia, MD; Neil O. Fishman, MD
Arch Intern Med. 2003;163(13):1618. doi:10.1001/archinte.163.13.1617-a.
Text Size: A A A
Published online


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" rather than as "inappropriate" given the obvious value judgment associated with the latter term and the fact that what is "appropriate" at one institution or setting may be "inappropriate" elsewhere.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also 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.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
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.


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

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

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

Articles Related By Topic
Related Collections
PubMed Articles