Respiratory fluoroquinolones (RFQs), because of their spectrum of activity and safety profile, are frequently prescribed for patients with respiratory complaints, even when evidence of infection is limited. In this study, frequency of such discretionary antibiotic use is examined in emergency department (ED) patients with a primary non-infectious diagnosis, before and after widespread availability of RFQs at the study hospital.
ED charts of all patients admitted with congestive heart failure (CHF) in 1998 (pre-RFQ era) and 2004 (post-RFQ era) were reviewed. Clinical data, antibiotic use, and rationale were compared between the groups.
29 of 311 CHF patients (9.3%) in 1998 received antibiotics compared to 25 of 196 patients (12.8%) in 2004 (p = 0.24). No difference in cough, sputum, leukocytosis, hypoxia, or x-ray findings was noted. In 1998, 10 of 29 patients (34.5%) who received antibiotics had a fever compared to 2 of 25 patients (8.0%) in 2004 (p = .02). In 1998, antibiotic rationale was documented for 72.4% of patients (21/29), suspected respiratory infection was the most common indication for antibiotic use (15 patients, 52%), and 13 of these 15 patients received a macrolide +/− ceftriaxone. In 2004, rationale was documented for 40% of patients (10/25, p = 0.03 compared to 1998), suspected respiratory infection was the indication in 5 patients, and 4 of these 5 patients received RFQs. 9 patients in 2004 (36% of antibiotic recipients and 4.6% of the CHF cohort) received RFQs for no documented reason.
Widespread availability of RFQs was not associated with increased overall antibiotic use, although fever was seen less frequently and antibiotics (predominantly RFQs) were prescribed more frequently without a documented indication in 2004. Analysis of antibiotic utilization in the ED offers insight into the potential impact of formulary selection and recent initiatives promoting early antibiotic therapy for patients with pneumonia.
Widespread RFQ availability may lead to increased prescribing in the absence of infectious symptoms.
Charulata Ramaprasad, No Financial Disclosure Information; No Product/Research Disclosure Information