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July 02, 2020

Retrospective study of the empiric use of fluoroquinolones for acute uncomplicated cystitis 1


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.


  • Retrospective study of non-pregnant females aged 19–64 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 symptoms of cystitis, allergy to nitrofurantoin, urine culture with a pathogen that was non-susceptible to nitrofurantoin within the previous year, long-term suppressive therapy with nitrofurantoin, creatinine clearance (CrCl) of <30 mL/min, or previously failed nitrofurantoin therapy.
  • The secondary outcome was predictors for fluoroquinolone vs nitrofurantoin use.

Key Results

pie chart
  • 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.


magnifying glass
  • Independent predictors of fluoroquinolone use were the clinic at which the patient was treated, increasing age, nitrofurantoin use within 90 days prior to encounter and previous urine culture within 1 year with an organism non-susceptible to nitrofurantoin.



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.



  1. Robinson TF, Barsoumian AE, Aden JK, Giancola SE. Evaluation of the trends and appropriateness of fluoroquinolone use in the outpatient treatment of acute uncomplicated cystitis at five family practice clinics. J Clin Pharm Ther. 2019 Dec 10. [Epub ahead of print]

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