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Thomas M. Hooton, MD; Walter E. Stamm, MD
Harborview Medical Center Seattle

JAMA. 1985;254(8):1034-1035.

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In Reply.—

We appreciate Dr Bailey's comments and agree that trimethoprim-sulfamethoxazole appears to be a more effective single-dose agent for treating acute bacterial cystitis than are penicillins and cephalosporins. A recent review of published studies found single-dose amoxicillin to be less effective (mean efficacy, 72%) than single-dose trimethoprim-sulfamethoxazole (mean efficacy, 90%).¹ However, the best single-dose treatment regimen(s) can be ascertained only through randomized comparative trials. The explanation for the apparent difference in efficacy of single-dose trimethoprim-sulfamethoxazole and amoxicillin is unclear. The prevalence of amoxicillin-resistant Escherichia coli strains exceeds that of trimethoprim-sulfamethoxazole-resistant strains in Seattle, and thus offers a partial explanation. However, many reported failures involve E coli susceptible to both drugs. It is likely, although unproved, that the lesser efficacy of the penicillins and cephalosporins relates to their more rapid elimination from the body. This interesting question deserves further investigation.

Regarding the antibody-coated bacteria test, published data demonstrate a . . . [Full Text PDF of this Article]

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