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Am Fam Physician. 2002;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.

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