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Published on: August 30, 2018
A simple intervention to reduce inappropriate ciprofloxacin prescribing in the emergency department
Mark Fagan1, Morten Lindbæk, Harald Reiso
1From the Institute of Health and Society, Faculty of Medicine, University of Oslo , Oslo , Norway.
Background:
According to Norwegian guidelines for antibiotic use in primary care, ciprofloxacin is reserved for complicated urinary tract infections (UTI). Despite these recommendations, ciprofloxacin use has increased in Norway in recent years. We aimed to reduce inappropriate ciprofloxacin prescribing in the emergency department.
Methods:
An intervention study was performed by removing ciprofloxacin from the local antibiotic formulary and including a suggestion list for antibiotic use with all point of care urine dipstick testing in an emergency department. An emergency department in the neighbouring county served as the control. Prescriptions for UTI were registered 1 y prior to and 1 y after the intervention.
Results:
In the targeted emergency department, there was a significant (p < 0.0001) reduction in ciprofloxacin prescribing for cystitis, while the use of mecillinam increased (p = 0.042). In the control department, prescribing of ciprofloxacin doubled (p < 0.0001).
Conclusions:
An intervention based on a therapy suggestion list and on limiting the availability of ciprofloxacin in the local formulary, resulted in treatment more in line with national guidelines by reducing ciprofloxacin and increasing mecillinam prescribing.
Insights
An intervention successfully reduced inappropriate ciprofloxacin prescribing for urinary tract infections (UTI) in an emergency department. This strategy aligned antibiotic use with national guidelines, decreasing ciprofloxacin and increasing mecillinam use.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Emergency Medicine
Background:
- Norwegian guidelines restrict ciprofloxacin for complicated urinary tract infections (UTI).
- Despite guidelines, ciprofloxacin use has risen in Norway.
- Inappropriate prescribing in emergency departments necessitates intervention.
Purpose of the Study:
- To decrease the inappropriate prescription of ciprofloxacin in an emergency department setting.
- To align antibiotic prescribing practices with national guidelines for UTI treatment.
Main Methods:
- Intervention study involving removal of ciprofloxacin from the formulary.
- Implementation of a suggestion list for antibiotic use alongside urine dipstick tests.
- Comparison with a control emergency department over a one-year period pre- and post-intervention.
Main Results:
- Significant reduction in ciprofloxacin prescribing for cystitis (p < 0.0001) in the intervention group.
- Increased mecillinam prescribing (p = 0.042) in the intervention group.
- Doubled ciprofloxacin prescribing in the control group (p < 0.0001).
Conclusions:
- A formulary restriction and suggestion list intervention effectively reduced ciprofloxacin use.
- The intervention promoted adherence to national guidelines for UTI treatment.
- Mecillinam use increased, indicating a shift towards recommended antibiotics.
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