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Fluoroquinolone use in a rural practice
Len Kelly1, Yoko S Schreiber2, Josh Hopko3
1Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Canada.
Introduction:
Fluoroquinolones (FQs) are a commonly prescribed class of antibiotics in Canada. Evidence of a constellation of possible adverse events is developing. Central and peripheral nervous system abnormalities and collagen-related events (including aortic aneurysm/dissection, tendinopathy/rupture and retinal detachment) are associated with FQ exposure in large population-based aftermarket studies. In 2017, Health Canada warned about rare FQ-related persistent or disabling side effects. This study explores FQ use in a rural community.
Methods:
Antibiotic prescriptions (including FQs) in the over 18 adult population (5416) were measured in the town of Sioux Lookout for 5 years, January 2013 to 31 December 2017.
Results:
FQ prescriptions accounted for 16.0% of adult antibiotics, superseded by penicillins (21.1%) and macrolides (18.2%). Ciprofloxacin accounted for one half of FQ use (51.2%), followed by levofloxacin (36.7%) and norfloxacin (13.3%). FQs were commonly used for respiratory (33%) and urinary tract infections (18%).
Conclusion:
Aftermarket evidence reports increased risk of 'disabling and persistent serious adverse events'(Health Canada) in patients using FQs. Appropriate clinical caution should be exercised in the prescribing of FQs. Common overuse seems to occur in the treatment of uncomplicated community-acquired pneumonia and cystitis, despite recommendations to use other antimicrobial agents as first-line treatments.
Insights
Fluoroquinolones (FQs) are frequently prescribed antibiotics, but carry risks of serious adverse events. This study highlights their common use and potential overuse in a rural Canadian community, urging clinical caution.
Area of Science:
- Pharmacology and Therapeutics
- Infectious Diseases
- Public Health
Background:
- Fluoroquinolones (FQs) are widely prescribed antibiotics in Canada.
- Growing evidence links FQ use to serious adverse events, including nervous system and collagen-related issues.
- Health Canada issued a warning in 2017 regarding rare, persistent, or disabling FQ side effects.
Purpose of the Study:
- To investigate the patterns of fluoroquinolone (FQ) utilization in a rural Canadian community.
- To assess the frequency and indications for FQ prescribing in an adult population.
Main Methods:
- A retrospective analysis of adult antibiotic prescriptions (n=5416) was conducted in Sioux Lookout from January 2013 to December 2017.
- Prescription data included fluoroquinolones (FQs) and other antibiotic classes.
Main Results:
- Fluoroquinolones (FQs) constituted 16.0% of adult antibiotic prescriptions.
- Ciprofloxacin (51.2%) and levofloxacin (36.7%) were the most common FQs used.
- FQs were frequently prescribed for respiratory (33%) and urinary tract infections (18%).
Conclusions:
- Despite evidence of increased risk for disabling and persistent adverse events associated with FQs, their use remains common.
- Overuse of FQs is noted for uncomplicated community-acquired pneumonia and cystitis, where first-line alternatives are recommended.
- Clinical caution is advised when prescribing fluoroquinolones (FQs) due to potential serious side effects.
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