In a new study, researchers found that many patients head home with prescriptions for fluoroquinolones — powerful but risky antibiotics.
This can increase their risk of everything from “superbug” infections to torn tendons.
In fact, the hospitals that said they are trying to reduce use of fluoroquinolones were twice as likely to discharge patients with a new prescription for one of the drugs in that risky group.
In all, one-third of the patients studied received a fluoroquinolone prescription at the end of their hospital stay, despite current guidelines calling for restricted use because of dangerous side effects.
The research was conducted by a team at Michigan Medicine.
Fluoroquinolones include name brands like Cipro and Levaquin as well as generic antibiotics whose names end in “-floxacin.”
They have been especially linked to the rise of drug-resistant organisms and potentially life-threatening gut infections with an opportunistic microbe called Clostridioides difficile.
They’ve also been linked to ruptures of Achilles tendons, dangerously low blood sugar levels in people with diabetes, and mental health problems including disorientation and delirium.
The U.S. Food and Drug Administration has issued several “black box” warnings about their side effects — most recently in December with a warning that fluoroquinolones could cause rupture of the aorta, the huge artery leading from the heart to the rest of the body.
That warning suggests doctors should not prescribe the drugs to the elderly, people with high blood pressure and people with a risk or history of aneurysms.
In the study, the team found across all 48 Michigan hospitals in the research, discharge-related prescriptions accounted for two-thirds of the fluoroquinolone supply prescribed to the nearly 12,000 patients treated for pneumonia or urinary tract infections.
The drugs accounted for 42% of all antibiotics prescribed at discharge.
The phenomenon observed in the study — where the hospitals that had active antimicrobial stewardship programs had higher rates of prescribing fluoroquinolones at discharge — deserves more scrutiny.
Fourteen hospitals in the study had measures in place to require the review of fluoroquinolone prescriptions during hospitalization.
In these hospitals, more than 78% of the supply of fluoroquinolones was prescribed at discharge, compared with 68% of the supply for the other 34 hospitals, nearly all of which had antimicrobial stewardship programs but no special emphasis on fluoroquinolones.
It may be that while pharmacists and infection prevention specialists are keeping an eye on in-hospital prescribing, they don’t have access to, or don’t focus on, the prescriptions written at discharge.
Electronic health record systems track both inpatient and discharge medications, but they are often in separate sections of the record.
The team says patients and their families can speak up about not wanting a fluoroquinolone in the hospital or at discharge, especially if they have conditions such as diabetes, high blood pressure, history of aneurysm, or tendon or muscle problems. Patients with a history of C. diff should be especially wary.
The lead author of the study is Valerie Vaughn, M.D., M.Sc., a hospital medicine specialist at Michigan Medicine.
The study is published in the journal Clinical Infectious Diseases.
Copyright © 2019 Knowridge Science Report. All rights reserved.
