» Articles » PMID: 38148474

Antibiotic Use in Hospital Urinary Tract Infections After FDA Regulation

Overview
Publisher Springer
Specialty General Medicine
Date 2023 Dec 26
PMID 38148474
Authors
Affiliations
Soon will be listed here.
Abstract

Background: The FDA issued a "black box" warning regarding risks of fluoroquinolones in 2008 with updates in 2011, 2013, and 2016.

Objective: To examine antimicrobial use in hospital-treated UTIs from 2000 to 2020.

Design: Cross-sectional study with interrupted time series analysis.

Participants: Patient encounters with a diagnosis of UTI from January 2000 to March 2020, excluding diagnoses of renal abscess, chronic cystitis, and infection of the gastrointestinal tract, lungs, or prostate.

Main Measures: Monthly use of fluoroquinolone and non-fluoroquinolone antibiotics were assessed. Fluoroquinolone resistance was assessed in available cultures. Interrupted time series analysis examined level and trend changes of antimicrobial use with each FDA label change.

Key Results: A total of 9,950,790 patient encounters were included. From July 2008 to March 2020, fluoroquinolone use declined from 61.7% to 11.7%, with similar negative trends observed in inpatients and outpatients, age ≥ 60 and < 60 years, males and females, patients with and without pyelonephritis, and across physician specialties. Ceftriaxone use increased from 26.4% encounters in July 2008 to 63.6% of encounters in March 2020. Among encounters with available culture data, fluoroquinolone resistance declined by 28.9% from 2009 to 2020. On interrupted time series analysis, the July 2008 FDA warning was associated with a trend change (-0.32%, < 0.001) and level change (-5.02%, p < 0.001) in monthly fluoroquinolone use.

Conclusions: During this era of "black box" warnings, there was a decline in fluoroquinolone use for hospital-treated UTI with a concomitant decline in fluoroquinolone resistance and rise in ceftriaxone use. Efforts to restrict use of a medication class may lead to compensatory increases in use of a single alternative agent with changes in antimicrobial resistance profiles.

Citing Articles

Impact of the US Food and Drug Administration warning regarding increased risk of aortic aneurysms or aortic dissections on fluoroquinolone prescribing trends.

Rizk J, Slejko J, Heil E, Seo D, Qato D BMJ Open Qual. 2024; 13(3.

PMID: 39053916 PMC: 11733791. DOI: 10.1136/bmjoq-2024-002925.

References
1.
Tran P, Antonelli P, Hincapie-Castillo J, Winterstein A . Association of US Food and Drug Administration Removal of Indications for Use of Oral Quinolones With Prescribing Trends. JAMA Intern Med. 2021; 181(6):808-816. PMC: 8056313. DOI: 10.1001/jamainternmed.2021.1154. View

2.
Ebell M . Treating adult women with suspected UTI. Am Fam Physician. 2006; 73(2):293-6. View

3.
McFarland L, Clarridge J, Beneda H, Raugi G . Fluoroquinolone use and risk factors for Clostridium difficile-associated disease within a Veterans Administration health care system. Clin Infect Dis. 2007; 45(9):1141-51. DOI: 10.1086/522187. View

4.
Park S . Third-generation cephalosporin resistance in gram-negative bacteria in the community: a growing public health concern. Korean J Intern Med. 2014; 29(1):27-30. PMC: 3932392. DOI: 10.3904/kjim.2014.29.1.27. View

5.
Rubino A, Sanon M, Ganz M, Simpson A, Fenton M, Verma S . Association of the US Food and Drug Administration Antipsychotic Drug Boxed Warning With Medication Use and Health Outcomes in Elderly Patients With Dementia. JAMA Netw Open. 2020; 3(4):e203630. PMC: 7189225. DOI: 10.1001/jamanetworkopen.2020.3630. View