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Fluoroquinolones most common UTI treatment despite black box warning

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August 16, 2018

Michael J. Durkin

A clinical practice guideline issued by the Infectious Diseases Society of America in 2011 that recommends health care providers avoid the use of fluoroquinolones for uncomplicated urinary tract infections had no significant impact on prescribing practices, according to a recent study.

Michael J. Durkin, MD, MPH, assistant professor in the division of infectious diseases at Washington University School of Medicine in St. Louis, and colleagues reported in Open Forum Infectious Diseases that fluoroquinolones (FQs) represented nearly half of outpatient antibiotic prescriptions for women with uncomplicated urinary tract infections (UTIs) in the United States.

“These results are particularly worrisome given the recent FDA black box warning to clinicians to avoid FQs for uncomplicated infections,” Durkin and colleagues wrote.

According to the researchers, FQs are known to increase the risk for infection and colonization with multidrug-resistant bacteria, including Clostridium difficile, and are associated with other notable adverse events, including tendonitis, delirium and cardiac complications.

“However, FQs have been historically popular with clinicians, representing 49% of all antibiotic prescriptions in outpatient settings between 2002 and 2011,” Durkin and colleagues wrote. “This high utilization places patients at high risk for adverse events and also likely facilitates the development of FQ-resistant pathogens.”

After its release in 2011, the IDSA’s clinical practice guideline was widely disseminated through review articles and published on the CDC’s website. To determine its impact on prescribing behavior, Durkin and colleagues conducted a retrospective cohort study using a nationally representative commercial insurance database with information on outpatient and ED visits for uncomplicated UTIs. The analysis included data on 654,432 women aged 18 to 44 years who received an antibiotic prescription after being diagnosed with an uncomplicated UTI between January 2009 and December 2013.

The data revealed that fluoroquinolones were the most commonly prescribed antibiotic before and after the clinical practice guidelines were released (45% vs. 42%). Treatment duration ranged from 3 to 10 days and was inappropriate more than 75% of the time, according to the researchers. Only 21% of FQ prescriptions, 26% of trimethoprim-sulfamethoxazole prescriptions and 16% of nitrofurantoin prescriptions were prescribed for the recommended duration.

“The publication of guideline recommendations may not be sufficient to meaningfully reduce inappropriate antibiotic use,” the researchers concluded. “Specific interventions are likely required to improve antibiotic prescribing practices. Active participation in antibiotic stewardship programs will be essential to improve antibiotic utilization, provide better patient care and combat antimicrobial resistance.” – by Stephanie Viguers

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Disclosures: The authors report no relevant financial disclosures.