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Fluoroquinolones were the most commonly prescribed class of antibiotics for adults in 2002
Despite the emergence of resistance to fluoroquinolone antibiotics among Streptococcus pneumoniae (which causes problems ranging from pneumonia and meningitis to ear and bloodstream infections), fluoroquinolones were the class of antibiotics most commonly prescribed for adults in 2002. Fluoroquinolone prescribing increased three-fold during visits to outpatient clinics and emergency departments (EDs) in the United States from 1995 (7 million visits) to 2002 (22 million visits). In addition, nearly half (42 percent) of these prescriptions were for conditions not approved by the FDA, such as acute bronchitis, otitis media, and acute upper respiratory tract infection, according to a study that was supported in part by the Agency for Healthcare Research and Quality (K08 HS14563 and HS11313).
The boost in fluoroquinolone prescribing was attributable to the introduction and use of newer, broader-spectrum fluoroquinolones with activity against S. Pneumoniae (for example, levofloxacin, gatifloxacin, and moxifloxacin). However, increased prescribing has led to the recent emergence of fluoroquinolone-resistant bacteria, according to Jeffrey A. Linder, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, and his colleagues. They suggest that efforts to improve prescribing should focus on otorhinolaryngologists and urologists, who are most likely to prescribe fluoroquinolones for unapproved conditions.
The researchers analyzed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey of adult visits to physicians in U.S. ambulatory clinics and EDs from 1995 to 2002. Fluoroquinolone prescribing increased as a proportion of overall antibiotic prescribing from 10 percent to 24 percent and as a proportion of the U.S. population from 39 to 106 prescriptions per 1,000 adults.
More details are in "Fluoroquinolone prescribing in the United States: 1995-2002," by Dr. Linder, Elbert S. Huang, M.D., M.P.H., Michael A. Steinman, M.D., and others in the March 2005 American Journal of Medicine 118(3), pp. 259-268.
Editor's Note: Another AHRQ-supported study on a related topic found that fluoroquinolone use for outpatients with community-acquired pneumonia increased from 24 to 39 percent from 2000 to 2002, while macrolide use decreased from 55 to 44 percent. Results suggested a lack of selectivity in reserving fluoroquinolones for higher risk patients. For more details, see MacDougall, C., Guglielmo, B.J., Maselli, J., and Gonzales, R. (2005, March). "Antimicrobial drug prescribing for pneumonia in ambulatory care." (AHRQ grant HS13003). Emerging Infectious Diseases 11(3), pp. 380-384.
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