Critical steps in fluoroquinolones and carbapenems prescriptions: results from a prospective clinical audit

Abstract

Antibiotic misuse is associated with emergence of resistance and high expenditures. Fluoroquinolones (FQ) and carbapenems (CP) are drugs with considerable potential of resistance development and its disseminated use is a concern. We undertook a prospective clinical audit to evaluate prescriptions of FQ and CP in a multistep process. Each prescription was unfolded in the following steps: indication for antimicrobial therapy; adequacy of initial prescription, dosage and route; previous cultures; and parenteral-oral transition. There was no antibiotics indication in 8.9% of FQ and 1.5% of CP group (p = 0.07). In CP 25.8% of initial schemes were inappropriate (21% in FQ). Lack of switch to oral therapy comprised 25% of monthly costs of FQ. Inadequacy in initial choice accounted for 13.6% of CP expenses. We concluded that, in spite of infection control restrictive policies, inappropriateness of antibiotic usage is worrisome. Clinical audit in a multistep approach may identify possible flaws in this process.

Dysglycemic Effect and Misuse Prevalence of Fluoroquinolones in ICU Diabetic Patients

“…Another issue that should be addressed is fluoroquinolones misuse. Fluoroquinolones are being prescribed for non-infectious/ non-bacterial indications which accounts for emerging resistance [25,26]. These antibiotics should be reserved for specific organisms which are resistant to other antibiotics.…”

“…These antibiotics should be reserved for specific organisms which are resistant to other antibiotics. Other ways of misuse include longer than appropriate duration of use, repeated antimicrobial coverage, inadequate coverage, empiric use of fluoroquinolones as in urinary tract infections (asymptomatic bacteriuria) [25,26]. All this leads to fluoroquinolone resistance together with unnecessary side effects that reduce the quality of patients' life [25,26].…”

Audit of the quality of medical care as a way to improve the efficiency of medical organizations

“…Необходимость строгого кон-троля в этой области связана не только с высокой сто-имостью некоторых антибактериальных препаратов, но и риском роста резистентности микрофлоры. С помощью клинического аудита были обнаружены факты примене-ния дорогостоящих, необоснованных антибактериаль-ных препаратов в дерматологии, неадекватного назна-чения фторхинолонов и карбапенемов, а также многие другие системные ошибки в назначении антибиотиков, антимикотиков и других препаратов [57][58][59][60][61][62][63][64][65].…”