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Fluoroquinolone use declines prior to FDA warning in Southeastern US hospitals

SAN FRANCISCO — Researchers observed a decline in fluoroquinolone use in Southeastern U.S. hospitals prior to FDA warnings recommending against using that class of antibiotics for treating uncomplicated infections — likely due to a successful antimicrobial stewardship program, according to research presented at IDWeek.

“Our study found an average of a 10% per-year reduction in fluoroquinolone (FQ) use in our stewardship network cohort over a recent 5-year period,” Michael Yarrington, MD, of the Duke Center for Antimicrobial Stewardship and Infection Prevention, told Infectious Disease News. “In addition, these data indicate that the 2016 FDA “black box” update had the adjunctive effect of an additional, immediate, 8% drop in fluoroquinolone use.”

The FDA issued a black box warning for FQs in June 2016, recommending that physicians avoid the treatment for uncomplicated infections. The agency updated its warnings in 2017 and 2018. Yarrington and colleagues also noted that many antimicrobial stewardship programs have set goals to reduce the use of FQs.

The researchers conducted a study of antimicrobial use in a cohort of hospitals in the Duke University Health System and an outreach network, which included 29 hospitals. Their analysis — an interrupted time series approach — looked at the long-term trends of antimicrobial use and the impact of the 2016 FDA safety announcement. They measured FQ and alternative antibiotic use in days of therapy (DOT) per 1,000 patient-days. The analysis, which spanned from 2013 to 2017, included a total 6,685,950 patient-days, and between eight and 29 hospitals reported antimicrobial use data each month.

The researchers said there was an overall 10% decrease in FQ use prior to the 2016 FDA warning, or a decline of approximately 1 DOT per 1,000 patient-days per month. Although there was a significant drop in FQ rates when the FDA announcement was made (P = .002), that did not equate to a significant change in the overall downward trend in use (rate ratio = 0.89; 95% CI, 0.79-1.01).

Results also showed that there was a significant increase in the use of community-onset agents, atypical agents and third-generation cephalosporins, whereas antipseudomonal beta-lactam use remained stable.

“The background reduction in FQ use that we saw likely reflects multifaceted local interventions implemented with the assistance of the Duke Antimicrobial Stewardship Outreach Network,” Yarrington said. “This study highlights the potential of national safety advisories to supplement these local stewardship activities, though frontline efforts from infectious disease clinicians and stewardship specialists will remain instrumental in ensuring future appropriate FQ use.”

During his presentation, Yarrington said that going forward, researchers should ask, “Are the effects we have seen in our study reflected on the national level, even in programs that have a less well-supported stewardship program?” – by Bruce Thiel

Reference:

Yarrington M, et al. Abstract 855. Presented at: IDWeek; Oct. 3-7, 2018; San Francisco.

Disclosures: The authors report no relevant financial disclosures.

SAN FRANCISCO — Researchers observed a decline in fluoroquinolone use in Southeastern U.S. hospitals prior to FDA warnings recommending against using that class of antibiotics for treating uncomplicated infections — likely due to a successful antimicrobial stewardship program, according to research presented at IDWeek.

“Our study found an average of a 10% per-year reduction in fluoroquinolone (FQ) use in our stewardship network cohort over a recent 5-year period,” Michael Yarrington, MD, of the Duke Center for Antimicrobial Stewardship and Infection Prevention, told Infectious Disease News. “In addition, these data indicate that the 2016 FDA “black box” update had the adjunctive effect of an additional, immediate, 8% drop in fluoroquinolone use.”

The FDA issued a black box warning for FQs in June 2016, recommending that physicians avoid the treatment for uncomplicated infections. The agency updated its warnings in 2017 and 2018. Yarrington and colleagues also noted that many antimicrobial stewardship programs have set goals to reduce the use of FQs.

The researchers conducted a study of antimicrobial use in a cohort of hospitals in the Duke University Health System and an outreach network, which included 29 hospitals. Their analysis — an interrupted time series approach — looked at the long-term trends of antimicrobial use and the impact of the 2016 FDA safety announcement. They measured FQ and alternative antibiotic use in days of therapy (DOT) per 1,000 patient-days. The analysis, which spanned from 2013 to 2017, included a total 6,685,950 patient-days, and between eight and 29 hospitals reported antimicrobial use data each month.

The researchers said there was an overall 10% decrease in FQ use prior to the 2016 FDA warning, or a decline of approximately 1 DOT per 1,000 patient-days per month. Although there was a significant drop in FQ rates when the FDA announcement was made (P = .002), that did not equate to a significant change in the overall downward trend in use (rate ratio = 0.89; 95% CI, 0.79-1.01).

Results also showed that there was a significant increase in the use of community-onset agents, atypical agents and third-generation cephalosporins, whereas antipseudomonal beta-lactam use remained stable.

“The background reduction in FQ use that we saw likely reflects multifaceted local interventions implemented with the assistance of the Duke Antimicrobial Stewardship Outreach Network,” Yarrington said. “This study highlights the potential of national safety advisories to supplement these local stewardship activities, though frontline efforts from infectious disease clinicians and stewardship specialists will remain instrumental in ensuring future appropriate FQ use.”

During his presentation, Yarrington said that going forward, researchers should ask, “Are the effects we have seen in our study reflected on the national level, even in programs that have a less well-supported stewardship program?” – by Bruce Thiel

Reference:

Yarrington M, et al. Abstract 855. Presented at: IDWeek; Oct. 3-7, 2018; San Francisco.

Disclosures: The authors report no relevant financial disclosures.

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