The appropriateness of oral fluoroquinolone-prescribing in the long-term care setting.
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Administration, Oral; Aged; Aged, 80 and over; Ciprofloxacin; Drug Costs; Drug Prescriptions; Drug Utilization Review; Female; Humans; Male; Medical Audit; Retrospective Studies; Skilled Nursing Facilities; United States
Health Services Research | Medicine and Health Sciences
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.
J Am Geriatr Soc. 1994 Jan;42(1):28-32.
Journal of the American Geriatrics Society
Pickering, Terri-Diann; Gurwitz, Jerry H.; Zaleznik, Dori; Noonan, James P.; and Avorn, Jerry, "The appropriateness of oral fluoroquinolone-prescribing in the long-term care setting." (1994). Meyers Primary Care Institute Publications and Presentations. 163.