Unnecessary use of fluoroquinolone antibiotics in hospitalized patients

Abstract

BackgroundFluoroquinolones 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). In this study, our aim was 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.MethodsWe conducted a 6-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 6 weeks after completion of therapy.ResultsOf 1,773 days of fluoroquinolone therapy, 690 (39%) 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% 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% of regimens), colonization by resistant pathogens (8% of regimens), and CDI (4% of regimens).ConclusionsIn our institution, 39% 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.

Multidrug-resistant North American pulsotype 2 Clostridium difficile was the predominant toxigenic hospital-acquired strain in the province of Manitoba, Canada, in 2006–2007

“…Kelly & LaMont (2008) hypothesized that fluoroquinolone resistance may have facilitated the spread of the NAP1/ ribotype 027 strain, potentially providing it with a survival advantage in the hospital environment where fluoroquinolone use may be pervasive. The unnecessary use of fluoroquinolones was reported recently by Werner et al (2011) to account for 39 % of days of fluoroquinolone therapy at one US hospital. It is possible that the prevalence of NAP2, in particular the 0003 subtype (Table 3), may also be expanding due to its propensity for fluoroquinolone resistance and its close association (91.0 %; Table 6) with hospital-acquired infection.…”

Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection

“…Based on institutional guidelines, between 30 and 81% of fluoroquinolone use is inappropriately prescribed within the emergency department and inpatient hospital settings (2,3).…”

Age-Stratified Treatment Response Rates in Hospitalized Patients with Clostridium difficile Infection Treated with Metronidazole

“…As many hospitalized patients receive unnecessary antibiotics for an extended duration, antimicrobial stewardship efforts to decrease unnecessary concomitant use of non-CDI antibiotics may improve treatment outcomes of patients with CDI (16,17). The reduction in these concomitant antibiotics may also help justify the use of moreexpensive, but more-effective, agents for the treatment of CDI.…”