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October 02, 2020
Retrospective study of the empiric use of fluoroquinolones for uncomplicated cystitis 1
Introduction
Current guidelines recommend avoiding fluoroquinolones as first-line treatment for uncomplicated cystitis, when possible, due to the risk of serious side effects. However, fluoroquinolones are still widely prescribed for this condition. This study evaluated the trends and appropriateness of empiric fluoroquinolone use compared to nitrofurantoin (recommended in this setting) for uncomplicated cystitis.
Methods
- Retrospective study of non-pregnant females aged 19–65 years prescribed ciprofloxacin, levofloxacin or nitrofurantoin within 7 days of a diagnosis of uncomplicated cystitis at five family practice clinics.
- The primary outcome was the appropriateness of empiric fluoroquinolone vs nitrofurantoin therapy according to various criteria including presence/absence of symptoms, history of drug allergy, recent history of pathogen susceptibility, kidney function, previous treatment response and receipt of suppressive therapy with nitrofurantoin.
- The secondary outcome was predictors for fluoroquinolone vs nitrofurantoin use.
Key Results
- Of 567 patient encounters, nitrofurantoin and fluoroquinolones were prescribed in 395 and 172 cases, respectively.
- Prescribing was considered appropriate in only 11% of cases treated with fluoroquinolones vs 87% of cases treated with nitrofurantoin (p<0.01).
- Most inappropriate use of fluoroquinolones (88%) was due to a lack of contraindications to nitrofurantoin use.
- Independent predictors of fluoroquinolone use were the clinic at which the patient was treated, age, nitrofurantoin use within 90 days prior to encounter and previous urine culture within 1 year with an organism non-susceptible to nitrofurantoin.
Conclusions
Despite guideline recommendations, fluoroquinolones are still widely prescribed for uncomplicated cystitis and their use for this indication is often inappropriate. This highlights the need for interventions and education to improve the use of fluoroquinolones and preserve their utility.
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