Although hospitals are making an effort to reduce the use of fluoroquinolones by their patients, many still discharge with prescriptions for the potentially dangerous antibiotic, according to a recent study.
“Fluoroquinolone antibiotics are easy to use, but carry a lot of risk for patients and society at large,” according to lead study author Valerie Vaughn, MD, MSc, a hospital medicine specialist at Michigan Medicine.
Fluoroquinolone Use in Hospitals
The retrospective cohort study included 11,748 patients (6,820 pneumonia, 4,928 positive urine culture) at 48 hospitals who were treated between December 2015 and September 2017. Researchers collected data pertaining to each hospital’s pre-prescription approval and/or prospective audit and feedback use to target fluoroquinolone prescribing during hospitalization (fluoroquinolone stewardship). After controlling for hospital clustering and patient factors, they evaluated inpatient and post-discharge fluoroquinolone exposure between hospitals with and without fluoroquinolone stewardship.
Researchers report that fluoroquinolones are the third most commonly prescribed antibiotic for adults, despite their known risks. More than 1 in 20 of those prescriptions were for conditions that did not even require antibiotics. https://t.co/nyw2fZeeZo pic.twitter.com/cozIgWyCEb
— WebMD (@WebMD) February 14, 2019
Among the 48 hospitals, 14 (29.2%) reported the use of pre-prescription approval and/or prospective audit and feedback in order to target fluoroquinolone. In adjusted analysis, researchers observed a correlation between fewer patients receiving a fluoroquinolone (37.1% vs 48.2%; P = 0.01) and fewer fluoroquinolone treatment days per 1,000 patients (2,282 vs. 3,096 days/1,000 patients; P = 0.01), which was attributed to lower inpatient prescribing. But two-thirds of fluoroquinolone treatment days were post-discharge, and new fluoroquinolone starts were nearly double in hospitals with fluoroquinolone stewardship compared to hospitals without (15.6% vs. 8.4%; P = .003).
The @US_FDA recently issued a new warning on fluoroquinolones and aortic rupture. How should this affect practice? https://t.co/S9pYfn0EbX pic.twitter.com/3WdClG7swM
— NEJM Journal Watch (@JWatch) February 13, 2019
“These results show we need to focus on not just their use in hospitals, but also in the prescriptions that we send patients home with,” said Vaughn. “Discharge prescribing is a big loophole.”
Adverse Effects Associated with Fluoroquinolone
Among hospital patients treated with antibiotics, 20% experience an antibiotic-related adverse event, according to the study authors. Fluoroquinolone antibiotics, such as ciprofloxacin, levofloxacin, moxifloxacin, are particularly associated with adverse outcomes.
In 2018 the U.S. Food and Drug Administration (FDA) strengthened the warning labels for fluoroquinolones due to their association with decreased blood sugar and mental health effects.
“The low blood sugar levels can result in serious problems, including coma, particularly in older people and patients with diabetes who are taking medicines to reduce blood sugar,” the FDA wrote, adding, “The mental health side effects to be added to or updated across all the fluoroquinolones are disturbances in attention, disorientation, agitation, nervousness, memory impairment, and serious disturbances in mental abilities called delirium.”
FDA warning for fluoroquinolones for patients at risk of aortic aneurysm from December. Probably not going to change my practice much as I hardly ever prescribe them. https://t.co/LREGUbqgQ3
— Kathryn Daveson (@KathrynDaveson) February 7, 2019
Since 2008 the FDA has released other warnings for safety issues associated with fluoroquinolones, including restricting use for certain uncomplicated infections, disabling side effects, peripheral neuropathy, tendinitis, and tendon rupture.
“More than 1 in 20 of those prescriptions, however, were for conditions that did not require #antibiotics, while nearly 20% were prescribed to treat infections for which they should not be used as the first treatment.” #Fluoroquinolones https://t.co/YrLBMKUSSc
— Marc Bubbs (@DrBubbs) February 13, 2019
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Source: Clinical Infectious Diseases
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