Fluoroquinolones are among the most commonly prescribed antimicrobials and are an important risk factor for colonization and infection with fluoroquinolone-resistant Gram-negative bacilli and for Clostridium difficile infection (CDI). Nicole L Werner, of the School of Medicine at Case Western Reserve University in Cleveland, and colleagues, sought to determine current patterns of inappropriate fluoroquinolone prescribing among hospitalized patients, and to test the hypothesis that longer than necessary treatment durations account for a significant proportion of unnecessary fluoroquinolone use.
The researchers conducted a six-week prospective, observational study to determine the frequency of, reasons for, and adverse effects associated with unnecessary fluoroquinolone use in a tertiary-care academic medical center. For randomly-selected adult inpatients receiving fluoroquinolones, therapy was determined to be necessary or unnecessary based on published guidelines or standard principles of infectious diseases. Adverse effects were determined based on chart review six weeks after completion of therapy.
Of 1,773 days of fluoroquinolone therapy, 690 (39 percent) were deemed unnecessary. The most common reasons for unnecessary therapy included administration of antimicrobials for non-infectious or non-bacterial syndromes (292 days-of-therapy) and administration of antimicrobials for longer than necessary durations (234 days-of-therapy). The most common syndrome associated with unnecessary therapy was urinary tract infection or asymptomatic bacteriuria (30 percent of all unnecessary days-of-therapy). Twenty-seven percent (60/227) of regimens were associated with adverse effects possibly attributable to therapy, including gastrointestinal adverse effects (14 percent of regimens), colonization by resistant pathogens (8 percent of regimens), and CDI (4 percent of regimens).
Werner, et al. concluded that in their institution, 39 percent of all days of fluoroquinolone therapy were unnecessary. Interventions that focus on improving adherence with current guidelines for duration of antimicrobial therapy and for management of urinary syndromes could significantly reduce overuse of fluoroquinolones. Their research was published in BMC Infectious Diseases.
Reference: Werner NL, Hecker MT, Sethi AK and Donskey CJ. Unnecessary Use of Fluoroquinolone Antibiotics in Hospitalized Patients. BMC Infectious Diseases 2011, 11:187doi:10.1186/1471-2334-11-187