Am Fam Physician. 2002 Sep 1;66(5):734.
to the editor: I enjoyed reading Drs. Oliphant and Green's comprehensive review entitled “Quinolones: A Comprehensive Review.”1 However, the premise that “Levofloxacin is an excellent first-line agent in the treatment of prostatitis” from the article and repeated in the “Clinical Quiz” may be misleading. I consider the cost of a treatment regimen in my empiric use of antibiotics in my practice. (I also use histamine H2 blockers as first-line treatment for gastroesophageal reflux disease instead of proton pump inhibitors.)
Most of the patients I see with acute prostatitis respond nicely to doxycycline ($15; 100 mg twice daily for 14 days) or trimethoprim-sulfamethoxazole (TMP-SMX; $25; 800 mg twice daily for 14 days). I reserve levofloxacin (Levaquin; $135; 500 mg once daily for 14 days) for treatment failures (of which I have few) or for more serious infections. Of course, if a urethral culture can be obtained, treatment may be modified.
We, as physicians and managers of health care, need to be acutely aware of the economic implications of our decisions, especially in these difficult financial times.
1. Oliphant CM, Green GM. Quinolones: a comprehensive review. Am Fam Physician. 2002;65:455–64.
Copyright © 2002 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions