Background Fluoroquinolones are antibiotics widely used because their spectrum is broad and they penetrate all human tissues well. However this abuse use leads to an increase in resistance. So, our institution decided to draw up prescribing recommendations for these antibiotics. Pharmacists must uphold these recommendations: Use levofloxacin only for pulmonary infections respecting national and European guidelines; Use ciprofloxacin only for pseudomonas infections or nosocomial infections; Use norfloxacin only for urinary infections and cirrhosis prophylaxis and use ofloxacin in all indications contained in the SPC.
Purpose To evaluate the impact of these recommendations on fluoroquinolones prescriptions.
Materials and methods A prospective study was conducted for three months in all units. Hospital of Narbonne, France.
We analysed all fluoroquinolones prescriptions over this period using our prescription software, DISPORAO. Criteria investigated were: indications, dose adaptation to renal function and justification of these prescriptions in the patient electronic record.
Results 186 prescriptions for fluoroquinolones were validated. Concerning levofloxacin, 22 of 23 prescriptions followed the recommendations (95%). We counted 132 prescriptions of ofloxacin, in various validated indications. And for ciprofloxacin, 9 of 17 prescriptions followed the recommendations (53%). 140 of 186 prescriptions were adapted to renal function (75%). 147 of 186 prescriptions were correctly justified in the patient electronic record (79%).
Conclusions Fluoroquinolones consumption remained stable at previous levels during this period. We saw that recommendations are fully respected for levofloxacin and followed reasonably well for ciprofloxacin, prescriptions for which came mainly from the cardiology unit. This exception can be explained by the habits of only one prescriber in the cardiology department. Moreover we saw that a quarter of prescriptions were not adapted to renal function. This study also showed that justification in the patient electronic record was being done correctly. Recommendations are generally respected and their content has been understood. Several avenues for improving fluoroquinolones prescriptions can be explored: IV/PO switching, revaluation at 48 h, duration of prescriptions and checking if fluoroquinolone has already been prescribed in the previous three months.
No conflict of interest.
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