Fluoroquinolone Utilization in the Emergency Departments of Academic
Medical Centers

Prevalence of, and Risk Factors for, Inappropriate Use

Ebbing Lautenbach, MD, MPH; Lori A. Larosa, PharmD; Nishaminy
Kasbekar, PharmD; Helen P. Peng, PharmD; Richard J. Maniglia, MD;
Neil O. Fishman, MD

Arch Intern Med.2003;163:601-605.

Background Resistance to fluoroquinolone (FQ) antibiotics has risen markedly in recent years and has been associated with increasing FQ use; however, few data exist regarding FQ use patterns. Designing strategies to limit FQ resistance byoptimizing FQ use depends on identifying patterns of inappropriate FQ use. Use of FQs in emergency departments (EDs) has not been studied.

Methods


We studied 100 consecutive ED patients who received an FQ and were subsequently discharged. Appropriateness of the indication for use was judged according to existing institutional guidelines. A case- control study was conducted to identify the prevalence of, and risk factors for, inappropriate FQ use.

Results

Of 100 total patients, 81 received an FQ for an inappropriate
indication. Of these cases, 43 (53%) were judged inappropriate
because another agent was considered first line, 27 (33%) because
there was no evidence of infection based on the documented
evaluation, and 11 (14%) because of inability to assess the need for antimicrobial therapy. Although the prevalence of inappropriate use was similar across various clinical scenarios, there was a
borderline significant association between the hospital in which the
ED was located and inappropriate FQ use. Of the 19 patients who
received an FQ for an appropriate indication, only 1 received both
the correct dose and duration of therapy.

Conclusions

Inappropriate FQ use in EDs is extremely common. Efforts to limit
emergence of FQ resistance must address the high level of
inappropriate FQ use in EDs. Future studies should evaluate the
impact of interventions designed to reduce inappropriate FQ use in
this setting.


Additional reference:

[Use of levofloxacin in the hospital] [Utilizacion hospitalaria de levofloxacino.] Rev Esp Quimioter 2003 Jun;16(2):221-6 (ISSN: 0214-3429)  Castells X; Vallano A; Campany D; Rigau D; Arnau JM  Servicio de Farmacologia Clinica, Fundacio Institut Catala de Farmacologia, Barcelona, Spain.