The Appropriateness of Oral Fluoroquinolone-Prescribing in the Long-Term Care Setting

J Am Geriatr Soc. 1994 Jan;42(1):28-32. doi: 10.1111/j.1532-5415.1994.tb06069.x.

Abstract

Objective: To evaluate the appropriateness of ciprofloxacin-prescribing in the long-term care setting.

Design: Retrospective chart review.

Setting: A large academically oriented long-term care facility.

Patients: Institutionalized elderly patients with a mean age of 88 years.

Methods: One hundred orders were randomly selected for review from all ciprofloxacin orders initiated over a 3-year period. Criteria for appropriateness of ciprofloxacin-prescribing were developed based on a comprehensive review of the medical literature. Evaluation of appropriateness of prescribing was based on the indication for therapy and the availability of more effective and/or less expensive alternative antibiotic regimens. Only information available to the physician at the time of the order was used to judge appropriateness. Abstracted medical records were evaluated independently by a geriatrician and an infectious diseases specialist.

Results: With respect to site of infection, the urinary tract accounted for 43% of all ciprofloxacin orders; the lower respiratory tract, 28%; and skin and soft-tissue infections, 17%. Only 25% of orders were judged appropriate. Twenty-three percent of orders were judged less than appropriate based on indication, and 49% due to the availability of a more effective and/or less expensive alternative antibiotic choice. There was insufficient information in the medical record to judge 3% of the orders.

Conclusion: These results indicate less than optimal prescribing of oral fluoroquinolones in the long-term care setting, with potential consequences including the development of resistant bacterial strains and increased health care costs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Ciprofloxacin / economics
  • Ciprofloxacin / therapeutic use*
  • Drug Costs
  • Drug Prescriptions* / economics
  • Drug Prescriptions* / statistics & numerical data
  • Drug Utilization Review*
  • Female
  • Humans
  • Male
  • Medical Audit
  • Retrospective Studies
  • Skilled Nursing Facilities / standards*
  • United States

Substances

  • Ciprofloxacin