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Inappropriate use of oral ciprofloxacin.

T R Frieden¹, R J Mangi

¹Infectious Disease Section, Yale University School of Medicine, New Haven, Conn.

|September 19, 1990

Summary

Ciprofloxacin, a widely used oral antibiotic, is often inappropriately prescribed for common infections where it is not effective. This misuse highlights the need for careful antibiotic selection to ensure proper patient care and combat resistance.

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Area of Science:

Pharmacology
Infectious Diseases
Antimicrobial Stewardship

Background:

Oral antibiotics represent a significant healthcare expenditure, exceeding $2.4 billion annually.
The introduction of newer antibiotics, such as ciprofloxacin, offers broad-spectrum activity but also increased potential for misuse and rising costs.
Ciprofloxacin, a systemic oral quinolone, has become a frequently prescribed antibiotic since its US release in 1987.

Observation:

Widespread inappropriate use of ciprofloxacin has been observed in clinical practice.
Several distinct patterns of ciprofloxacin misuse have been identified.
The antimicrobial activity of ciprofloxacin against certain pathogens, including streptococci, anaerobes, and Mycoplasma, is limited.

Findings:

Ciprofloxacin demonstrates intermediate to poor efficacy against streptococci, anaerobic organisms, and Mycoplasma.
While ciprofloxacin can be valuable for specific oral therapies, it is frequently misused as an initial treatment for common outpatient infections.
Infections such as otitis media, sinusitis, pharyngitis, and pneumonia are often inappropriately treated with ciprofloxacin.

Implications:

The findings underscore the critical need for improved antimicrobial stewardship programs to guide appropriate antibiotic prescribing.
Optimizing ciprofloxacin use can help preserve its effectiveness and reduce the development of antibiotic resistance.
Educating healthcare providers on appropriate indications for ciprofloxacin is essential to prevent misuse and ensure patient safety.

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