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Open Access Highly Accessed Research article

Unnecessary use of fluoroquinolone antibiotics in hospitalized patients

Nicole L Werner1, Michelle T Hecker2, Ajay K Sethi3 and Curtis J Donskey4*

Author Affiliations

1 School of Medicine, Case Western Reserve University, 10,000 Euclid Avenue, Cleveland, Ohio, USA

2 Division of Infectious Diseases, MetroHealth Medical Center, 400 MetroHealth Drive, Cleveland, Ohio, USA

3 Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

4 Geriatric Research, Education and Clinical Center, Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, Ohio, USA

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BMC Infectious Diseases 2011, 11:187  doi:10.1186/1471-2334-11-187

Published: 5 July 2011

Abstract

Background

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). 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.

Methods

We 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.

Results

Of 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).

Conclusions

In 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.