A reader suggested that our July 23 article on Drugs for Urinary Tract Infection1 should have included information on the cost of the drugs we recommended for treatment of acute uncomplicated cystitis.

Trimethoprim/sulfamethoxazole DS — Generic formulations are available at large discount pharmacies for $4 for 20 tablets. Trimethoprim/sulfamethoxazole DS is generally found on tier 1 (lowest co-pay) of insurance company formularies.

Nitrofurantoin monohydrate/macrocrystals — The wholesale acquisition cost of the generic formulation is about $2.50 per tablet.2 The drug is on tier 1 of some insurance company formularies, but on tier 2 or 3 of others.

Fosfomycin — Available only as Monurol, a single dose of fosfomycin is effective in most cases of acute uncomplicated cystitis, but the manufacturer charges a wholesale acquisition cost of more than $40 for that dose.2 Most insurance companies place Monurol on tier 3 of their formularies, or do not include it on their formularies at all.

Not recommended: Ciprofloxacin – Fluoroquinolones should not be used empirically to treat acute uncomplicated cystitis. The fact that ciprofloxacin is available at large discount pharmacies for $4 for 20 500-mg tablets and is on tier 1 on most insurance company formularies may be part of the reason for its continued overuse.