Authors’ Objectivity Is in Doubt

Abstract

The guideline on uncomplicated urinary tract infections recommends fosfomycin as first-line treatment—an antibiotic that first entered the market in the 1980s as a back-up antibiotic for multiresistant Staphylococci, and which up to the present time can be used for just this purpose in MRSA patients. In E coli infections, it has resistance rates of below 10%—in other words, an important, still highly effective antibiotic. What will happen to this substance if it is now used in cases of uncomplicated cystitis—now, that a preparation for oral administration has been available for several years? Presumably, resistance patterns will take a similar course as they did for quinolones, which in the 1980s were the only oral antibiotic used in Pseudomonas infections; were used widely, especially for urology patients; and nowadays have a resistance rate of 25–30%. Is there a compelling reason to use fosfomycin widely in primary care this early on, opening the doors to the development of resistance? The physicians who are most often confronted with uncomplicated cystitis (general practitioners, pediatricians, gynecologists) have expressed a rather disapproving attitude via their specialist societies (see also FRAUENARZT 2/11). In spite of this the guideline has been compiled. Three of the authors reported having received funding from Pierre-Fabre, the manufacturers of Monuril® (fosfomycin trometamol). Professor Wagenlehner reported ties to 19 pharmaceutical manufacturers, including Pierre-Fabre. In a scenario of such close ties to the drug industry I ask myself whether the recommendations for the use of antibiotics were actually derived from objective and independent assessments, such as physicians and patients expect from a guideline.