Lauri A. Hicks
About one-quarter of all fluoroquinolone prescriptions for adults receiving ambulatory care in the United States were given for conditions that do not require antibiotic treatment or those with a different recommended first-line therapy, according to data recently published in Clinical Infectious Diseases.
In light of these findings, the CDC released a statement reminding health care providers to prescribe fluoroquinolones only “when absolutely necessary” because of the serious adverse events they may cause.
“Fluoroquinolones’ side effects can involve tendons, muscles, joints, nerves and the central nervous system, or could lead to life-threatening Clostridium difficile infection, which causes diarrhea that can lead to severe colon damage and death,” the statement said. “Because of these serious side effects, in 2016, the [FDA] issued a warning advising health care providers to not use fluoroquinolones for conditions for which alternative and effective treatment is available and when the potential risks outweigh the benefits.”
Lauri A. Hicks, DO, director of the CDC’s Office of Antibiotic Stewardship, and colleagues examined trends in fluoroquinolone prescribing using information from IQVIA, the CDC’s National Center for Health Statistics’ National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Survey. They found that 31.5 million fluoroquinolones were prescribed to adults during ambulatory care visits in 2014. Genitourinary conditions (24.5%) and respiratory conditions (21.6%) accounted for the largest proportion of these prescriptions.
Approximately 6.3 million fluoroquinolone prescriptions — or 19.9% — were for sinusitis and uncomplicated urinary tract infections (UTIs) — both of which have a different recommended first-line treatment. In addition, about 1.6 million (5.1%) fluoroquinolones were prescribed for viral respiratory tract infections and bronchitis, even though these conditions do not require antibiotic treatment. Data further showed that fluoroquinolones were the most commonly prescribed antibiotic for uncomplicated UTIs (40.3%) and the third most commonly prescribed antibiotic for respiratory conditions.
Although the data cannot confirm the reasons for fluoroquinolone overprescribing, the researchers speculated that it may be due the efficacy, broad-spectrum activity, “favorable pharmacokinetics” and “perceived safety” of drugs. Several surveys have shown that, in the outpatient setting, health care providers often feel pressured to prescribe antibiotics because they believe patients expect to receive them. Although this may be the case for some, study author Katherine E. Fleming-Dutra, MD, medical epidemiologist with the CDC’s Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, said most patients just want effective communication.
“Communicating effectively with the patient on when an antibiotic is needed or not and what their diagnosis is can be really helpful in ensuring patient satisfaction,” Fleming-Dutra told Infectious Disease News.
Clinicians, she added, may also prescribe antibiotics if they are unsure what the diagnosis is, which could result in unnecessary treatment. Emerging data further suggests that workload and prescribing habits may be additional contributing factors, Fleming-Dutra said.
“It is really important for us in public health and antibiotic stewardship to understand reasons why clinicians are prescribing antibiotics inappropriately,” she said. “It is not always a knowledge issue — often clinicians do know what the appropriate treatment is — but these pressures are affecting them. It will be key to understand these barriers so that antibiotic stewardship efforts can improve prescribing practices.” – by Stephanie Viguers
Disclosures: Fleming-Dutra, Hicks and colleagues report no relevant financial disclosures.