Less than 1 in 5 fluoroquinolone prescriptions appropriate in long-term care facilities
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Oral fluoroquinolones were prescribed appropriately only 15% of the time in long-term care facilities, according to results of a retrospective chart review published in the Journal of the American Geriatrics Society.
“The current rate of appropriate fluoroquinolone use in long-term care is unknown; thus, this study was designed to characterize the appropriateness of fluoroquinolone use in long-term care,” Amie T. Blaszczyk, PharmD, head of the geriatrics and pediatrics division at Texas Tech University Health Sciences Center School of Pharmacy in Dallas, and colleagues wrote.
Researchers reviewed 222 prescriptions among 200 patients (48% men) in 19 long-term care facilities. They were looking for three components of appropriate fluoroquinolone use: duration, indication and renal function. Researchers also ascertained which patients had drug-drug interactions and risk factors related to an FDA warning surrounding fluoroquinolone use (eg, aged 60 years and older, concomitant QT-prolonging medications and concomitant corticosteroids).
Blaszczyk and colleagues found that only 33 prescriptions (15%) met all three components of appropriate fluoroquinolone use. In addition, 47% of the orders had missing data, primarily indication for use and serum creatinine. Also, 85% of prescriptions were for patients aged 60 years or older, 26% indicated one or more scheduled QT-prolonging medications and 2.7% indicated an oral corticosteroid.
“Although 47% of prescriptions had missing data could be seen as a limitation, we also view it as a strength, highlighting how common lack of appropriate documentation is for antimicrobial stewardship in the long-term care setting,” Blaszczyk and colleagues wrote. “Improved patient assessment, monitoring, and documentation are needed to optimize fluoroquinolone use in this vulnerable patient population.” – by Janel Miller
Disclosures: Blaszczyk reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.
Perspective
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Elizabeth Dodds Ashley, PharmD
Sadly, the findings by Blaszczyk and colleagues are not surprising to me. Though fluoroquinolones are an area of rapidly evolving safety label changes, we know from several different studies that communicating these safety label changes to the medical community is difficult. Even in instances where the prescriber is aware of a label change tied to these antibiotics, the prescriber is more likely to only rely on their own past experiences with the agents which are often associated as being safe and efficacious.
Perhaps the only way to change Blaszyzck and colleagues’ findings or to increase awareness of fluoroquinolones safety alerts is to provide prescribers with immediate feedback when they write prescriptions for these antibiotics.
But how we do this? Do we create and share prescribers report cards on these prescriptions in high-risk environments like long-term care facilities? Do we develop the infrastructure that would prompt electronic health records to remind the physician of how many times they have prescribed fluoroquinolones in the past few months and how dangerous that could be to the patient? A key part of the feedback loop is missing in that often prescribers do not know that a patient has a particular adverse event such as Clostridioides difficile infection after prescribing an antibiotic. Perhaps part of the solution is to provide that feedback, so there is a better appreciation of the downstream consequences of prescribing these agents. Bringing the consequences of fluroquinolones home to a prescriber’s practice is more likely to be effective than to communicate an FDA warning alone.
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