THE APPROPRIATENESS OF ORAL FLUOROQUINOLONE-PRESCRIBING IN THE LONG-TERM-CARE SETTING

Objective: To evaluate the appropriateness of ciprofloxacin-prescribing in the long-term care setting. Design: Retrospective chart review. Setting: A large academically oriented long-term care facility. Patients: Institutionalized elderly.patients with a mean age of 88 years. Methods. One hundred orders were randomly selected for review from all ciprofloxacin orders initiated over a 3-year period. Criteria for appropriateness of ciprofloxacin-prescribing were developed based on a comprehensive review of the medical literature. Evaluation of appropriateness of prescribing was based on the indication for therapy and the availability of more effective and/or less expensive alternative antibiotic regimens. Only information available to the physician at the time of the order was used to judge appropriateness. Abstracted medical records were evaluated independently by a geriatrician and an infectious diseases specialist. Results: With respect to site of infection, the urinary tract accounted for 43% of all ciprofloxacin orders; the lower respiratory tract, 28%; and skin and soft-tissue infections, 17%. Only 25% of orders were judged appropriate. Twenty three percent of orders were judged less than appropriate based on indication, and 49% due to the availability of a more effective and/or less expensive alternative to antibiotic choice. There was insufficient information in the medical record to judge 3% of the orders. Conclusion: These results indicate less than optimal prescribing of oral fluoroquinolones in the long-term care setting, with potential consequences including the development of resistant bacterial strains and increased health care costs.