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SIDNEY M. WOLFE, M.D., EDITOR MARCH 2002 VOL. 8, NO. 3

Direct-To-Consumer Advertising—Education or Emotion Promotion?

This article by Worst Pills, Best Pills tests to diagnose and drugs to treat Food and Drug Administration News Editor, Dr. Sidney Wolfe is illnesses is an important advance, (FDA) of advertising regulations reprinted from the New England confusion arises when commercially adequate? What can be done to Journal of Medicine 2002;346:524-526. driven promotional information is neutralize the negative effect of this Copyright © 2002 Massachusetts represented as educational. Two type of advertising? Medical Society. All rights reserved. articles in this issue of the Journal In an excellent review of direct- address the direct-to-consumer to-consumer promotion, Mintzes uring the past two decades, promotion of medical products and stated that “the question is not there has been an irrevers- services. Rosenthal et al. describe whether consumers should obtain D ible change in the nature of the resources allocated to direct-to- information about treatment op- the doctor-patient relationship. consumer advertising of prescrip- tions; the question is whether drug Patients are seeking much more tion drugs, as compared with other promotion—whose aim is to sell a medical information and are actively forms of promotion. Lee and product—can provide the type of participating in decisions affecting Brennan examine issues arising information consumers need.” their health. Intruding into this trend from the direct-to-consumer market- Addressing the issue of pharma- has been the rise of direct-to-con- ing of high technology medical ceutical advertising more generally sumer promotion, which, in its initial screening tests. These articles raise 30 years ago in the Journal, thrust, bypasses primary care doctors several questions. Is direct-to- Ingelfinger argued that “advertise- and other physicians. Although consumer advertising educational ments should be overtly recognized increased access by patients to or emotional? How often is it for what they are—an unabashed accurate, objective information about misleading? Is enforcement by the continued on page 18

In this Issue citalopram...... 22 loratadine...... 20 PROZAC ...... 22 CLARINEX...... 20 LUVOX ...... 22 ranitidine ...... 24 acetaminophen CLARITIN...... 20 MAALOX ...... 24 SARAFEM...... 22 and tramadol ...... 22 clomipramine...... 22 MARPLAN ...... 22 sertraline ...... 22 ADIPOKINETIX ...... 21 desloratadine ...... 20 META-BURN ...... 21 SPECTRACEF...... 23 ADRENALIN ...... 21 ELAVIL ...... 22 moclobemide ...... 22 ST. JOHN’S WORT...... 22 ALPHADRINE ...... 21 ephedra...... 21 NARDIL ...... 22 TAGAMET ...... 24 amitriptyline...... 22 ephedrine...... 21 norephedrine ...... 21 tramadol ...... 22 ANAFRANIL...... 22 EPHEDRINE 25 ...... 21 OMNICEF ...... 24 tranylcypromine ...... 22 cefdinir ...... 24 EPHEDROL ...... 21 OVERDRIVE...... 21 ULTRACET ...... 22 cefditoren...... 23 fluoxetine ...... 22 PARNATE ...... 22 ULTRAM ...... 22 cefpodoxime ...... 24 fluvoxamine ...... 22 paroxetine ...... 22 VANTIN ...... 24 CEFTIN ...... 24 histamine-2 blockers ...... 24 PAXIL ...... 22 ZANTAC ...... 24 cefuroxime ...... 24 HOLLYWOOD CUTS ...... 21 phenelzine ...... 22 ZOLOFT ...... 22 CELEXA ...... 22 isocarboxazid...... 22 PHENYLKINETICS ...... 21 cephalexin ...... 24 KEFLEX...... 24 phenylpropanolamine ...... 21 cimetidine ...... 24 LIPODRYL II...... 21 PPA ...... 21

MARCH 2002 17 attempt to get someone to buy parts of the brain where gut in- published. According to another something, although some useful stincts are formed, areas that study, consumers rated the safety information may be provided in the influence emotional behavior and and appeal of drugs described with process.” He suggested that such form memories.” The advertising an incomplete statement of risks advertising should be divested of its agency asserts that its “communica- more positively than similar drugs “pseudo-educational character.” tions are focused on making the described with a more complete Serious deficiencies have been hippocampus respond positively to statement of risks. documented in the educational your product...[by demonstrating] Defenses of direct-to-consumer value of advertising for prescription how your product is superior and advertising by the pharmaceutical drugs. In a survey of 1872 viewers unique.” An executive of a company industry inevitably mention that the of television advertisements, 70 that focuses on direct-to-consumer real gatekeeper is the doctor, since percent thought they had learned only the doctor can write a prescrip- little or nothing more about the tion. Even Rosenthal et al. state that health condition requiring treat- doctors will only write a prescrip- ment, and 59 percent thought they The FDA should tion for a drug when they are knew little or nothing more about “familiar with it and comfortable the drug being advertised. Another crack down harder prescribing it.” Although it is study found that whereas many beyond the scope of this editorial, it advertisements provided informa- on misleading ads. is important to examine studies tion about the name and symptoms assessing the accuracy of sources of of the disease for which the drug information that physicians use to was being promoted, few educated learn about new drugs or devices. the patients about the success rate of advertising commented that “con- There is evidence that many drug the drug, the necessary duration of sumers react emotionally, so you advertisements are not balanced or use, alternative treatments (includ- want to know how they feel about accurate, and duped gatekeepers ing behavioral changes) that could your message and what emotional may not adequately resist patients’ improve their health, or misconcep- triggers will get them to act....We exhortations to write a prescription. tions about the disease to be treated. want to identify the emotions we Since a ban on the advertising of The average number of “educational can tap into to get that customer to pharmaceutical agents is incompat- codes” (i.e., specific learning points take the desired course of action.” ible with the First Amendment, relating to a medical condition or a Another article, describing problems much stricter control by the FDA of treatment) present in the advertise- the drug industry has had in misleading advertising is necessary. ments was only 3.2 out of a possible adapting to direct-to-consumer Although expenditures for the 11. marketing, said that companies “are promotion of drugs increased from None of these deficiencies should overly focused on communicating $11 billion in 1997 to $15.7 billion in be surprising in the light of the rational attributes to customers. But 2000 (see Figure 1, next page), there characterization of advertising by consumers often choose a product is a significant decrease in the the Canadian economist Stephen on [the basis of] emotional number of actions taken by the FDA Leacock as “the science of arresting attributes....How an emotional to enforce advertising regulations— the human intelligence long enough appeal fits into fair balance in from 139 letters of warning to to get money from it.” Leacock also advertising prescription drugs companies or notices of violation in thought that, for the purpose of under the requirements and ap- 1997 to 79 in 2000 and an estimated selling, advertising “is superior to proval process of the FDA is not 73 in 2001. The FDA is grossly reality.” An advertisement, aimed at clear.” understaffed for this important the marketers of pharmaceutical Patients have dangerous oversight function: the entire products, from an agency that misperceptions about direct-to- Division of Drug Marketing, Adver- creates drug advertisements, consumer advertising. According to tising, and Communications provides some revealing insights one study, a substantial proportion (DDMAC) has had only 28 to 30 about how the process works. The of people incorrectly believed that employees since 1997. A further promotional material describes the only the safest and most effective handicap for the FDA is that it lacks hippocampus as the “prescription- drugs could be advertised directly the legal authority to impose civil writing center of the brain”—the to consumers and that the FDA monetary penalties on companies part that “processes information by required that it be allowed to review even when they repeatedly violate connecting new concepts with the advertisements before they were the law. An editorial in a December

18 Worst Pills, Best Pills News 2001 issue of Business Week com- mented that “pharmaceutical company advertising on TV pro- motes high-priced new drugs with marginal improvement over cheaper generic versions. The FDA should crack down harder on misleading ads.” In the realm of screening computed tomograpic CT scans analyzed by Lee and Brennan, enforcement is beginning to occur. FDA recently sent a notice of violation to a company, CATscan2000, for illegally promot- ing screening for heart disease in asymptomatic people: this form of technology has not been approved for use in such screening. Beyond increased enforcement by the FDA, the issue of better informa- tion for patients must be addressed. The irritation felt by many physi- cians when patients approach them after seeing a direct-to-consumer that “direct-to-consumer advertis- to promote drugs. Public Health advertisement may derive from the ing is an excellent way to meet the Service agencies such as the Na- fact that such advertisements, with growing demand for medical tional Institutes of Health and the their powerful, emotion-arousing information, empowering consum- FDA, along with medical educators images and frequently unbalanced ers by educating them about health in schools and residency programs, information on safety and effective- conditions and possible treat- must move much more forcefully to ness, mislead patients into believing ments.” replace tainted drug company that drugs are better than they The education of patients—or “education” with scientifically actually are. There is a hollow ring physicians—is too important to be based, useful information that will to the statement by Pharmaceutical left to the pharmaceutical industry, stimulate better conversations Research and Manufacturers of with its pseudo educational cam- between doctors and patients and America President Alan Holmer paigns designed, first and foremost, lead to true empowerment.

Editor: Sidney M. Wolfe, M.D. © Public Citizen/Health Research Group 2002 All rights reserved. Managing Editor: Phyllis McCarthy WORST PILLS Published monthly by Public Citizen’s Health Staff Researcher: Larry D. Sasich, Pharm.D. BEST PILLS Research Group. ISSN 1080-2479 Information Specialist: John Paul Fawcett NEWS Contributing Editor: William Hines Proofreader: Benita Marcus Adler The Health Research Group was co-founded in 1971 by Ralph Nader and Graphic Production: Kristy I. Jackson Sidney Wolfe in Washington, D.C., to fight for the public’s health, and to give President: Joan Claybrook consumers more control over decisions that affect their health. Founder: Ralph Nader Material in the Worst Pills, Best Pills News may not be reprinted without permission from the Editor. Send letters and requests to Worst Pills, Best Pills News Editor, 1600 20th Street NW, Washington, DC 20009.

Worst Pills, Best Pills News is a member of ISDB, Annual subscription price is $20.00 (12 issues); two year subscription $36.00. a network of independent drug bulletins which Mail subscriptions and address changes to Worst Pills, Best Pills News, Circula- aims to promote international exchange of tion Department , 1600 20th Street NW, Washington, DC 20009. quality information on drugs and therapeutics. Our website address is http://www.citizen.org/hrg

MARCH 2002 19 The Antihistamine Desloratadine (CLARINEX)— Son of Loratadine (CLARITIN)

y the time you read this, soon going to lose its patent protec- and can be less safe than drugs desloratadine (CLARINEX)— tion. The question for the company already on the market. Without Bthe Schering-Plough was: how to protect loratadine’s evidence from head-to-head clinical Corporation’s replacement for their market share to keep potential trials testing a new drug against an $3 billion a year antihistamine investors interested and old drug, ethical managed care loratadine (CLARITIN)—will be on current stock holders happy? organizations realize they would be pharmacy shelves. An army of sales Schering-Plough used a simulta- buying a “pig in a poke.” people will be bribing your doctor neous two pronged attack. First, So, how does Schering-Plough with expensive meals, gifts, and they hired an army of Washington plan to sell desloratadine when less vacations to switch your prescrip- lobbyists spending millions trying expensive generic loratadine will be tion from loratadine to deslor- to buy a three year patent extension on the market in 10 months? Yet atadine. Executives of your man- for loratadine. When that failed, the another tactic, other than those aged care organization or insurance company abused the intent of our mentioned in the first paragraph of company, depending on their patent laws to reward ingenuity and this article, is to offer desloratadine concept of medical ethics, will be originality to get desloratadine, the at a discount compared to huddled in a back room with metabolite of loratadine, protected loratadine. The wholesale list price Schering-Plough representatives and then got desloratadine past the for desloratadine has been an- negotiating for kickbacks, deep Food and Drug Administration’s nounced at $1.83 per tablet, com- discounts or other favors, to make (FDA) outmoded 40 year old legal pared to $2.22 for loratadine, a desloratadine the preferred antihis- standard for marketing drugs, difference of $0.39 per tablet. tamine on their drug formularies. which does not require new drugs A Wall Street analyst hit the nail Desloratadine is only technically to be better than older ones. on the head when he said “While a new drug. Patients who have been Schering-Plough now has two the steep discount will mean less taking loratadine since it was antihistamines protected by pat- revenue growth for Schering in the approved in 1994 actually have been ents—loratadine and deslor- short term, it will be beneficial over getting a dose of desloratadine atadine—that are inherently the the longer term because it will because loratadine is broken down, same. With only 10 months left on speed up recruitment of Claritin or metabolized, to desloratadine in loratadine’s patent, the goal is to [loratadine] users to Clarinex the body. Desloratadine is thereby switch as many patients as possible [desloratadine].” Put another way, produced as an active metabolite of to the “new” desloratadine with its in the long term consumers will loratadine. longer patent protection. This have their pockets picked by Loratadine is due to lose its effectively extends Schering- Schering-Plough if they start using patent protection in December 2002 Plough’s brand name monopoly in desloratadine. and Schering-Plough’s purpose in the antihistamine market for the life Alas, the anarchy of the American developing desloratadine can only of the desloratadine patent and the “health care” system. be to protect its share of the brand company prays it will blunt generic name antihistamine market. It was competition to loratadine. What You Can Do certainly not to produce a safer or However, Schering-Plough has more effective antihistamine. The run into one very large hitch. There There is no medical reason for market for this drug alone accounts are no studies or data to show that you to be switched from loratadine for about one-third of the company’s loratadine and desloratadine are to desloratadine. However, if you worldwide sales. clinically different. And ethical use desloratadine in the short term The market share protection managed care organizations and before generic loratadine is available scheme works like this. Loratadine insurance companies are waking up you will save money. If you use has been Schering-Plough’s golden to the fact that new drugs making it desloratadine after generic goose for years racking up tens of through the FDA’s drug approval loratadine is marketed you will be billions in sales, but loratadine is process may be no more effective ripped-off.

20 Worst Pills, Best Pills News Ephedra Dietary Supplements Laced with Synthetic Stimulants

strongly worded letter from the Health Research Group, PRODUCT PRODUCER Adated January 31, 2002, admonished Department of Health ADIPOKINETIX Syntrax Innovations, Inc. and Human Services secretary PO Box 1593 Tommy Thompson that his Cape Girardeau, MO 63702 “… Department has been grossly ADRENALIN Genapharm, negligent in protecting Americans PO Box 2558 from what is clearly the most Ceder Park, TX 78641 dangerous drug that masquerades as ALPHADRINE Pro-Muscle a food supplement, Ephedra. At least Address not available 10 products made by nine dietary EPHEDRINE 25Scientifically Advanced Nutrition Corporation supplement producers are now 4230 Del Rey Ave. # 458 being sold on the Internet—products Marina Del Rey, CA 90292 that illegally contain dangerous EPHEDROL Thermal Plus synthetic derivatives of ephedra.” 900 Greenbank Rd. Suite 522 Secretary Thompson was specifically Nepean, Ontario K2J-4P6 asked to order the seizure of these HOLLYWOOD CUTS Scientifically Advanced Nutrition Corporation illegally marketed products. 4230 Del Rey Ave. # 458 A list of these producers and their Marina Del Rey, CA 90292 products appear in the box on this LIPODRYL II Thermolife page. The text of the letter is avail- 720 El Camino Real #101 able on our web site at Belmont, CA 94002 www.citizen.org/publications/ META-BURN EXTREME Metabolic Response Modifiers release.cfm?ID=7146. A hard copy of 236 Calle Pintoresco this document can be obtained by San Clemente, CA 92673 writing to us at 1600 20th Street, NW, Washington, DC 20009. OVERDRIVE 7th Millennium Nutrition P.O. Box 2206 Ephedra is an herb that contains a Stow, OH 44224 number of substances that are chemically similar to the amphet- PHENYLKINETICS 21st Century Nutritionals / Synergy Nutritionals amines (“speed” like substances) 745 Hollywood Blvd. N.W., Ft. Walton Beach FL 32548 such as ephedrine and norephedrine (also known as phenylpropanola- mine or PPA). Data from the Food and Drug Administration’s (FDA) of dietary supplements containing reached after a risk assessment Center for Food Safety and Applied ephedra and the chemicals derived concluded that these products pose Nutrition’s Special Nutritionals from this herb. Prior to this, on a serious health risk. Secretary Adverse Event Monitoring System October 19, 2000, we had also Thompson should look north for shows that dietary supplements petitioned the FDA to ban all over- guidance. containing these chemicals are the-counter (OTC) uses of PPA. The U.S. law is very clear on adding associated with more reports of FDA is now in the process of synthetic compounds to dietary death, heart attack, heart rhythm formally removing PPA from all supplements. The Food, Drug and disturbances, high blood pressure, prescription and OTC products. Cosmetic Act expressly limits stroke and seizure than all other On January 9, 2002, Canadian dietary supplements to ingredients dietary supplements combined. regulatory authorities announced that are concentrates, metabolites The Health Research Group the initiation of a voluntary recall of (breakdown products), constituents, petitioned the FDA on September 5, certain products containing Ephedra or extracts of dietary substances. 2001 to ban the production and sale and ephedrine. This decision was continued on page 22

MARCH 2002 21 Do Not Use! The Pain Drug Tramadol (ULTRAM/ULTRACET) and Serotonin Syndrome

ustralian drug regulatory the 10 clinical features listed. These authorities have received must occur following either the Features of Serotonin Syndrome A 171 reports of suspected addition of a new drug that in- published in the American adverse reactions with the pain creases serotonin levels or an Journal of Psychiatry 1991. drugs tramadol (ULTRAM) or increase in the dose of a drug that tramadol in combination with raises serotonin levels. • mental status changes acetaminophen (ULTRACET) since Four of the six reports of seroto- (confusion, mild degree of Ultram began being marketed in nin syndrome to the Australian mania) Australia in late 1998. In six of these authorities described the use of • agitation reports, a very serious adverse tramadol in patients who were also • myoclonus (spasm or reaction known as the serotonin taking antidepressants known to twitching) syndrome was listed as the adverse increase the concentration of • hyperreflexia (reflexes are reaction. Tramadol is a drug that serotonin in the brain. These exaggerated) increases serotonin levels by block- included the selective serotonin ing the storage of the chemical in reuptake inhibitors (SSRIs) • sweating nerve cells. A summary of these sertraline (ZOLOFT) and citalopram • shivering reports was published in the De- (CELEXA), the selective monoam- • tremor cember 2001 issue of the Australian ine oxidase inhibitor (MAOI) • diarrhea Adverse Drug Reactions Bulletin. moclobemide (a drug not available • incoordination The box on this page lists the in the U.S. that releases serotonin • fever features of the serotonin syndrome. from nerve cells), and a combina- To establish the existence of this tion of the tricyclic antidepressants condition in a patient at least 3 of amitriptyline (ELAVIL) and clomipramine (ANAFRANIL), both of which block the storage of SSRI Drugs EPHEDRA, from page 21 serotonin in cells. citalopram (CELEXA) Our letter concludes by inform- Lists of currently marketed SSRIs ing Secretary Thompson that and MAOIs appear on the box on fluoxetine (PROZAC) this page. “Failure to act swiftly and decisively fluvoxamine (LUVOX) in this matter as required by law Another of the six reports and to ban all ephedra alkaloids will involved a person who was taking paroxetine (PAXIL) result in a continuation of the harm the dietary supplement St. John’s sertraline (ZOLOFT) and injury of dietary supplement Wort, also believed to increase consumers nationwide and will serotonin levels. The final report Fluoxetine is also marketed for emphasize how fraudulent your described the use of a relatively premenstrual dysphoric concerns about food safety are.” high daily dose of tramadol, 400 disorder as SARAFEM. milligrams, in an elderly man. Four What You Can Do of the six patients recovered after treatment while one patient re- MAOI Antidepressants You should not use any dietary quired admission to the intensive supplements other than vitamins care unit and had not recovered at isocarboxazid (MARPLAN) and minerals. Even supplement the time the Australian Adverse Drug phenelzine (NARDIL) producers who do not lace their Reactions Bulletin summary was products with synthetic substances published. The outcome was tranylcypromine (PARNATE) are not required to show that what unknown in another patient. they are selling is either safe or Tramadol was approved for use effective for any purpose. continued on page 23

22 Worst Pills, Best Pills News Do Not Use Until 2007! Cefditoren (SPECTRACEF)—Old Japanese Antibiotic Debuts In U.S.

efditoren (SPECTRACEF) company failed to prove that cef- was approved for sale by ditoren was of value in the treat- C the Food and Drug Admin- Cefditoren can ment of sinus infection. istration (FDA) in November 2001 The drug’s professional product making it the 23rd member of the interact with labeling or “package insert” con- cephalosporin family of antibiotics tains two unusual contraindications (semisynthetic relations of penicil- antacids for using cefditoren. First, the drug lin) and the 11th member of the sub- should not be used in patients with group known as third generation carnitine deficiency or congenital cephalosporins. The drug has been containing errors of normal metabolism that available in Japan since 1994. may result in a clinically significant We have invoked our Do Not Use magnesium and carnitine deficiency. Cefditoren can Until Five Years After Release rule cause a decrease in blood levels of with this drug. The Five Year Rule aluminum carnitine of 39 percent to 63 percent is described in the box on pg. 24. depending on the dose of the drug. The drug is being sold by TAP hydroxides Progressive muscle weakness and Pharmaceuticals Inc., a joint venture breakdown of muscle (rhabdo- between Abbott Laboratories of myolysis) are associated with severe Illinois and the Japanese firm carnitine deficiency. However, Takeda Chemical Industries. structure infections caused by neither of these adverse effects has Cefditoren is approved only for bacteria that will be killed by been reported with the use of use in adults and adolescents 12 cefditoren. Company press releases cefditoren at this time. years of age or older for the treat- indicate that TAP asked the FDA for The second contraindication to ment of acute worsening of chronic approval for the treatment of sinus using cefditoren is in patients who bronchitis, sore throat or tonsillitis, infection (acute bacterial sinusitis) are truly allergic to milk products and uncomplicated skin and skin as an approved use. But, the continued on page 24

SEROTONIN SYNDROME, tramadol with acetaminophen deaths with combined adminis- from page 22 (ULTRACET) was listed as Do Not tration. Concomitant use of in this country by the Food and Use in the October 2001 issue of ULTRAM with MAO inhibitors Drug Administration (FDA) in Worst Pills, Best Pills News for the or SSRIs increases the risk of March 1995. We listed the drug as same reasons tramadol was listed as adverse events, including seizure Do Not Use in the 1999 edition of Do Not Use. and serotonin syndrome. Worst Pills, Best Pills because it Both ULTRAM and ULTRACET appears to be no more and some- carry the same warning about using What You Can Do times less effective than the combi- either product with MAO inhibitors nation of codeine with acetami- or SSRI antidepressants and seroto- You should not be using tramadol nophen. In addition, shortly after nin syndrome. either in the form of ULTRAM or the drug was approved safety ULTRACET if you are taking an MAO warnings had to be added to its Use with MAO Inhibitors and inhibitor or SSRI antidepressant. professional product labeling, or Serotonin Re-uptake Inhibitors If you develop the symptoms of “package insert,” about the risk of Use ULTRAM with great caution serotonin syndrome while taking seizure or convulsion with its use in patients taking monoamine tramadol, immediately discontinue and its ability to cause dependence. oxidase inhibitors. Animal the tramadol and contact your The newly marketed combination of studies have shown increased doctor.

MARCH 2002 23 CEFDITOREN, from page 23 (not lactose intolerance which is an The Health Research Group’s Five Year Rule inability to breakdown lactose) because the drug contains sodium You should wait at least five years from the date of release to take caseinate, a milk protein. any new drug unless it is one of those rare “breakthrough” drugs that Cefditoren can interact with offers you a documented therapeutic advantage over older proven antacids containing magnesium and drugs. New drugs are tested in a relatively small number of people aluminum hydroxides such as before being released, and serious adverse effects or life-threatening MAALOX to reduce the amount of drug interactions may not be detected until the new drug has been cefditoren in the blood. It is recom- taken by hundreds of thousands of people. A number of new drugs mended that cefditoren not be taken have been withdrawn within their first five years after approval. Also, with the histamine-2 blocker drugs warnings about serious new adverse reactions have been added to the commonly used for heartburn. labeling of a number of drugs, or new drug interactions have been Using these drugs with cefditoren at detected, usually within the first five years after a drug’s release. the same time will also reduce the blood levels of cefditoren. The histamine-2 blockers include advertise directly to physicians or cimetidine (TAGAMET) and consumers the promotion of a new ranitidine (ZANTAC). This drug offers brand name drug like cefditoren is The Medical Letter On Drugs and essentially unopposed. Drug Therapeutics reviewed cefditoren in no documented companies know if they can get a their January 21, 2002 issue. The drug through the FDA’s outdated 40 Medical Letter editors concluded: advantage over year old standard for marketing It offers no clinical advantage over drugs (not requiring new drugs to be cefdinir (OMNICEF) or cefpodoxime better than old ones) they can make a (VANTIN), but it costs less. Older numerous other financial killing on the strength of drugs that have narrower spectrums their advertising campaign. of activity are as effective as cef- antibiotics ditoren for the approved indications, What You Can Do and are less likely to promote emergence of resistance. Cephalexin The third generation cepha- You should not take cefditoren (KEFLEX, and others), for example, losporin sub-group of antibiotics is a for at least five years, until 2007. would be a better choice for skin and mature market segment. Many of This drug offers no documented soft tissue infection, and cefuroxime the drugs in this sub-group have advantage over numerous other (CEFTIN) for bronchitis. Penicillin been on the market for years and are antibiotics that are equally or more remains the drug of choice of strep- available as lower cost generics. effective than older antibiotics tococcal pharyngitis or tonsillitis. Since generic manufacturers do not approved for the same uses.

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