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Physicians Still Contributing to Antibiotic Resistance by Inappropriate Prescription Practices: Presented at IDSA

By Maury M. Breecher, PhD, MPH

SAN DIEGO, CA -- October 22, 2003 -- Busy clinicians are prescribing the broad spectrum antibiotic levofloxacin in a "knee-jerk" response to poorly supported diagnoses of urinary tract infections (UTIs) based on urine analysis's alone, asymptomatic bacteriuria and unsubstantiated prostatitis, according to a study by researchers at University of Kentucky Medical Center Lexington, Kentucky, United States.

Malkanthie I McCormick, MBBS, presented the findings of a survey at the 41^st Annual Meeting of the Infectious Disease Society of America (IDSA), held here October 9-12.

Dr. McCormick conducted two retrospective reviews of medical records 6 months apart to assess prescribing practices. The randomly selected medical records were analysed to determine what medical services were provided and for supporting evidence of infection. Then an educational intervention was designed that included mandatory antibiotic approval by the medical centre's infectious disease department, dissemination of information about the recommended clinical pathways for diagnosis and treatment of UTIs, and education of clinicians regarding appropriate use of levofloxacin. Another medical record review was conducted ten months after the intervention.

The total number of patients receiving levofloxacin prescriptions dropped from a pre-intervention high of 239 to 162 and the number of patients receiving refills dropped from 34% to 1.2% However, when the numbers were further analysed, it was noted that the majority of the decrease in prescriptions came from the urology service, not primary care providers or the urgent care/emergency departments.

Diagnosis of UTI based on urine analysis alone, asymptomatic bacteriuria, and unsubstantiated prostatitis were the major indications for inappropriate level use, stated Dr. McCormick in her presentation.

"When we examine the reason for prescribing this antibiotic, we found that there was little objective evidence of infection in patients who were given the antibiotic," said Dr. McCormick. "Physicians were giving antibiotics as a knee-jerk reaction to patient complaints. Busy practitioners seem reluctant to follow national guidelines and recommended clinical pathways because they perceive that further investigations are time consuming and less cost effective than prescribing a broad spectrum agent."

"According to the literature, this is a problem not only here in Kentucky, but worldwide," Dr. McCormick said in an interview. "In light of concerns about antibiotic resistance, medical doctors should follow recommendations made by their professional associations regarding diagnosis and appropriate prescribing of antibiotics such as levofloxacin."

In a another study presented at the IDSA meeting Diego, one funded by Ortho-McNeil Pharmaceutical, Raritan, New Jersey, levofloxacin was found to be one of the declining number of antibiotics still effective against Streptococcus pneumoniae.

The study, led by Daniel F. Sahm, Clyde Thornsberry Focus Technologies, Herndon, Virginia, United States, analysed in vitro susceptibility to penicillin, azithromycin, amoxicillin-ciavulanate, ceftriaxone, trimethoprim-sulfamethoxazole, ciprofloxacin, gatifoxacin, levofloxacin and moxifoxacin.

The drugs were tested against 4,456 isolates of S. pneumoniae. The isolates showed antimicrobial resistance most frequently to azithromycin, penicillin and trimethoprim-sulfamethoxazole. Resistance to levofloxacin, gatifoxacin, and moxifoxacin remained lower than 1%.


[Study titles: Abstract 147: Antimicrobial Prescribing Practice in the Outpatients: A Daunting Challenge for Antibiotic Control. Abstract 201: Rates of Antimicrobial Resistance among Clinical Isolates of Streptococcus Pneumoniae in the United States: Results from the TRUST 7 (2002-2003) Surveillance Study.]

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