Regional variation in the potentially inappropriate first-line use of fluoroquinolones in Canada as a key to antibiotic stewardship? A drug utilization review study

BMC Infectious Diseases

for the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators¹  Pierre Ernst²  Audray St-Jean²  Ingrid S. Sketris³  Jianguo Zhang⁴  Fawziah Marra⁵  Jacqueline Quail⁶  Nick Daneman⁷  Dan Chateau⁸  Matthew Dahl⁸  Shawn Bugden⁹ 

[1] ;Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital;College of Pharmacy, Dalhousie University;Department of Medicine, Cumming School of Medicine, University of Calgary;Faculty of Pharmaceutical Sciences, University of British Columbia;Health Quality Council;Institute for Clinical Evaluative Sciences;Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba;School of Pharmacy, Health Sciences Centre, Memorial University of Newfoundland;

关键词: Antibiotics;    Fluoroquinolones;    Utilization;   

DOI  :  10.1186/s12879-021-06467-z

来源: DOAJ

【 摘 要 】

Abstract Background Serious adverse effects of fluoroquinolone antibiotics have been described for more than decade. Recently, several drug regulatory agencies have advised restricting their use in milder infections for which other treatments are available, given the potential for disabling and possibly persistent side effects. We aimed to describe variations in fluoroquinolone use for initial treatment of urinary tract infection (UTI), acute bacterial sinusitis (ABS), and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the outpatient setting across Canada. Methods Using administrative health data from six provinces, we identified ambulatory visits with a diagnosis of uncomplicated UTI, uncomplicated AECOPD or ABS. Antibiotic exposure was determined by the first antibiotic dispensed within 5 days of the visit. Results We identified 4,303,144 uncomplicated UTI events among 2,170,027 women; the proportion of events treated with fluoroquinolones, mostly ciprofloxacin, varied across provinces, ranging from 18.6% (Saskatchewan) to 51.6% (Alberta). Among 3,467,678 ABS events (2,087,934 patients), between 2.2% (Nova Scotia) and 11.2% (Ontario) were dispensed a fluoroquinolone. For 1,319,128 AECOPD events among 598,347 patients, fluoroquinolones, mostly levofloxacin and moxifloxacin, ranged from 5.8% (Nova Scotia) to 35.6% (Ontario). The proportion of uncomplicated UTI and ABS events treated with fluoroquinolones declined over time, whereas it remained relatively stable for AECOPD. Conclusions Fluoroquinolones were commonly used as first-line therapies for uncomplicated UTI and AECOPD. However, their use varied widely across provinces. Drug insurance formulary criteria and enforcement may be a key to facilitating better antibiotic stewardship and limiting potentially inappropriate first-line use of fluoroquinolones.

【 授权许可】

Unknown