The use of amoxicillin and clavulanic acid and quinolones as first choice antibiotics in uncomplicated urinary tract infections in Spain should be reviewed.

Urinary tract infections (UTI) represent a common problem in primary care consultations.1 Uncomplicated communityacquired cystitis is caused by Escherichia coli in approximately 90% of cases.2 The current management of acute uncomplicated cystitis is usually empirical, with neither urine cultures or susceptibility testing being used to guide therapy. Thus, empirical treatment in UTIs should cover E. coli. Resistance of this bacterium to amoxicillin and clavulanic acid and quinolones, albeit variable, is increasing in Spain and may lead to clinical failure.3 The aim of this study was to evaluate the non-susceptibility of Escherichia coli to five commonly prescribed antibiotics in 2006 and 2009. A retrospective analysis of susceptibility towards five antimicrobial agents (amoxicillin and clavulanic acid, cefuroxime, third generation cephalosporins -expressed as percentage of extended-spectrum -lactamases -ciprofloxacin, trimethoprim and sulfamethoxazole, and fosfomycin) among E. coli strains was carried out in urine cultures requested in 2006 and 2009 by primary care physicians, microbiologists and doctors working in the hospital setting. The susceptibility to these antibiotics was determined using automatic microdilution systems -Microscan (Baxter), Wider (Soria-Melguizo), Vitek (Bio-Mérieux) and Phoenix (Bekton-Dickinson) and/or disc-plates. The participating centres were the Hospital of Basurto (Bilbao), Bon Pastor laboratory (Barcelona), Hospital of Donostia (San Sebastián),