A Retrospective Evaluation of Fluoroquinolone Antibacterial Selection in a U.S. Community Hospital

Fluoroquinolones with enhanced antibacterial activity against respiratory tract pathogens, in particular Streptococcus pneumoniae, have been introduced into clinical practice. Of these fluoroquinolones, levofloxacin has been most widely prescribed. Coincident with its use, a significant decrease in fluoroquinolone activity against Pseudomonas aeruginosa was noted in a community hospital in the northeastern U.S. This finding prompted a retrospective audit of fluoroquinolone prescribing at this institution. Employing a modified Delphi approach, an independent panel of outside experts evaluated the selection and use of the 8 fluoroquinolones currently available for the treatment of varying infectious conditions, and when appropriate, recommended alternative therapeutic regimens in cases where the fluoroquinolone regimen employed was deemed to be suboptimal. Of the 43 clinical cases submitted, 38 (88%) were evaluable. Although the assessors concluded that fluoroquinolone therapy was justified in 73.7% of the evaluable cases, in many instances an alternative fluoroquinolone regimen was considered preferable, for reasons such as suboptimal antibacterial activity of the selected agent against some of the more commonly encountered bacterial species (namely, Pseudomonas aeruginosa and Streptococcus pneumoniae), the potential for undesirable drug-drug interactions, and issues of drug tolerability. The results of this retrospective analysis of antibacterial prescribing patterns suggest that the more targeted use of such agents as ciprofloxacin and newer 8-methoxy fluoroquinolones may have avoided the apparent trend toward reduced fluoroquinolone susceptibilities observed at the study hospital.