Azithromycin doesn’t beat doxycycline in the treatment of pelvic inflammatory disease (PID) on at least one count (“Azithromycin for PID beats doxycycline on all counts,” J Fam Pract. 2007;56:1006-1009.)
For a cash-paying patient, the recommended dose of azithromycin will cost approximately $42 (local pharmacy, as of December 4, 2007) to $60, while doxycycline will run between $4 (at pharmacies with special pricing on some generics) and $10.1 The cost-effectiveness assessment cited in the article2 based their analysis on prices of $18 vs $5 for the respective drugs, using wholesale acquisition costs in 1996.
William Hay, MD
University of Nebraska Medical Center, Omaha
whay@unmc.edu
Drs. Rowland and Ewigman respond
You make a great point. For the individual patient who is short on cash, a costeffective analysis based on old cost data is not particularly relevant. Doxycycline does work for the outpatient management of PID, just not quite as well as azithromycin, so it seems to us like a perfectly good choice when personal circumstances dictate. The cost difference is no doubt a relevant issue for many of our patients, and we appreciate you taking the time to point out this omission in our PURL.
Kate Rowland, MD
Bernard Ewigman, MD MSPH
VU Medical Center
Department of Family Medicine
The University of Chicago
be.editor@gmail.com