Is This how Times Are Changing?

Abstract

What does uncomplicated really mean, and why does such an infection require treatment with different antibiotics? In my surprise at reading the clinical guideline I reached for my bookshelf for Antibiotika Therapie by C Simon und W Stille (7th edition), which dates back to 1989, in order to establish details about the older urinary tract antibiotics that seem to be recommended for first-line therapy these days. The book says that mecillinam (as ester pivmecillinam, p 68) is a highly effective broad spectrum penicillin, and that fosfomycin was contraindicated during pregnancy (p 204) and is associated with the development of secondary resistance in vitro and in vivo. As far as the chemotherapeutic substance nitrofurantoin is concerned, I wish to quote verbatim from the book (p 256) in German, paraphrasing in English: “Indications: when weighing up the advantages and disadvantages of nitrofurantoin it is vital to substantially reduce the indications of nitrofurantoin and recommend this preparation only as a back-up chemotherapeutic substance for particular forms if urinary tract infections … incorrect indications: Nitrofurantoin should not be used any longer to treat uncomplicated urinary tract infections in women…”. The contraindications include pregnancy, owing to the drug’s mutagenicity. For further explanations see the 11th edition (2). Is this how times are changing? Furthermore, I wish to express unease at almost all authors’ multifarious ties to the pharmaceutical industry.