163. The Misuse of Ciprofloxacin In Outpatient Treatment of Acute Uncomplicated Cystitis (AUC)
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • The Misuse of Ciprofloxacin In Outpatient Treatment of Acute Uncomplicated Cystitis (AUC).pdf (360.5 kB)
  • Background: Fluoroquinolones are efficacious and most commonly used in patients with Acute Uncomplicated Cystitis (AUC).  However, they have the potential to cause significant “collateral damage” due to development of antibiotic resistance and secondary infections, both of which are more common with fluoroquinolone use as compared to other antibiotic classes.  The 2010 IDSA AUC Guidelines recommend the use of nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin, or pivmecillinam (unavailable in the US) as first-line therapy for AUC (Acute Uncomplicated Cystitis).  Per IDSA guidelines, ciprofloxacin should be reserved for important uses other than AUC and when used for AUC, should only be considered as an alternative antimicrobial therapy.

    Methods: This study is a retrospective chart review that examined all patients with AUC at Kaiser Permanente Fontana Medical Center who were prescribed ciprofloxacin.  Included patients: non-pregnant females between the ages of 18 and 65.  Excluded patients: male patients, pregnant women, females > 65 years old, and patients with pyelonephritis, renal stones, ESRD on hemodialysis, or anatomical abnormalities.  Data were analyzed using descriptive statistics with 95% confidence intervals.

    Results: 494 patient charts met criteria to be included in the study.  Review of charts showed that ciprofloxacin was inappropriate, 464/494 charts  (94%) of the time (95% CI - 455 to 472).  The reasons that it was inappropriate were:  297/494 (60%):  no previous urine culture showing resistance to other antibiotics (95% CI - 288 to 305);  418/494 (85%):  inappropriate ciprofloxacin dosage (95% CI - 409 to 426);  49/494 (10%):  h/o UTI with resistance to ciprofloxacin (95% CI - 40 to 57).  Furthermore, 85% of the time (95% CI - 410 to 427), the duration of ciprofloxacin was incorrect;  the range of days prescribed was 7 to 10 days.

    Conclusion: Chart review revealed more than 90% incidence of inappropriate ciprofloxacin prescription (incorrect therapy, too high dosage, too extended duration).  This result underscores the critical importance of developing sustained provider interventions and outpatient antibiotic stewardship programs to improve patient care and cost savings.

    Dinh Nguyen, MD1, Jana Dickter, MD2, Richard Guo, MD3 and Philomena Cho, MD3, (1)Family Medicine, Kaiser Permanente Fontana Medical Center, Fontana, CA, (2)Infectious Diseases, Kaiser Permanente, Fontana, CA, (3)Internal Medicine, Kaiser Permanente Fontana Medical Center, Fontana, CA

    Disclosures:

    D. Nguyen, None

    J. Dickter, None

    R. Guo, None

    P. Cho, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.