Fluoroquinolone use remains target for stewardship despite decrease in inpatient use
A decrease in inpatient fluoroquinolone use, particularly in regard to ciprofloxacin, served as the primary driver behind a decrease in overall use of fluoroquinolones at Veterans Affairs, or VA, hospitals in a 3-year period, according to findings from a retrospective cohort study.
“We know that fluoroquinolone antibiotics are commonly used. We also know that there are harmful side effects, like Clostridioides difficile infections, tendon rupture, aortic dissection and antibiotic resistance that are linked to fluoroquinolones,” Valerie M. Vaughn, MD, MSc, assistant professor of medicine in the division of hospital medicine at the University of Michigan and VA Ann Arbor Healthcare System, told Healio. “Because of these harms, antibiotic stewardship programs have really tried to restrict the use of fluoroquinolones for situations that really need them. For many patients, there are safer and more narrow-spectrum antibiotics that can be used instead.”
Fluoroquinolones are oral medications that have broad spectrum use and are inexpensive, she continued. As a result, they’re often they're the “go to” medications at discharge, even if they're not the best choice.
“We wanted to know is whether fluoroquinolone use is also decreasing as an antibiotic choice as patients leave the hospital,” Vaughn said.
Vaugh and colleagues conducted a retrospective cohort study of people hospitalized with infections at 125 VA hospitals between Jan. 1, 2014 and Dec. 31, 2017. The researchers examined inpatient and discharge fluoroquinolone use, including ciprofloxacin, levofloxacin and moxifloxacin, as a proportion of hospitalizations with a fluoroquinolone prescription and fluoroquinolone-days per 1,000 hospitalizations. According to the study, the researchers examined hospital-level variation and longitudinal prescribing trends after adjusting for illness severity, comorbidities and age.
Of the 560,219 hospitalizations with infections, 209,602 (37.4%) had a fluoroquinolone prescribed either during hospitalization (32.5%) or at discharge (19.6%). According to the study, almost all measures of fluoroquinolone use declined between 2014 and 2017, with the largest decreases observed for inpatient fluoroquinolone and ciprofloxacin use. The researchers observed a minimal decline in fluoroquinolone use at discharge, which accounted for a growing number of hospitalization-related fluoroquinolone days (52% in 2014; 61.3% by 2017).
The results indicate that clinicians “need to start looking at antibiotic use beyond the four walls of the hospital,” which includes antibiotics that are prescribed during care transitions, according to Vaughn.
“It's also likely not a coincidence that levofloxacin, which is often used to treat pneumonia, is increasing in use, while ciprofloxacin, which is often used to treat urinary tract infections, is decreasing,” she said. “The guidelines for those two diseases have approached their recommendations for fluoroquinolone prescribing very differently.”
National guidelines that took stewardship principles into account when making disease-specific recommendations for antibiotic use “would really help combat antibiotic resistance,” Vaughn added.