Fluoroquinolone use in a rural practice.
Introduction
Fluoroquinolones (FQs) are a commonly prescribed class of antibiotics in Canada. Evidence of a constellation of possible adverse events is developing. Central and peripheral nervous system abnormalities and collagen-related events (including aortic aneurysm/dissection, tendinopathy/rupture and retinal detachment) are associated with FQ exposure in large population-based aftermarket studies. In 2017, Health Canada warned about rare FQ-related persistent or disabling side effects. This study explores FQ use in a rural community.


Methods
Antibiotic prescriptions (including FQs) in the over 18 adult population (5416) were measured in the town of Sioux Lookout for 5 years, January 2013 to 31 December 2017.


Results
FQ prescriptions accounted for 16.0% of adult antibiotics, superseded by penicillins (21.1%) and macrolides (18.2%). Ciprofloxacin accounted for one half of FQ use (51.2%), followed by levofloxacin (36.7%) and norfloxacin (13.3%). FQs were commonly used for respiratory (33%) and urinary tract infections (18%).


Conclusion
Aftermarket evidence reports increased risk of 'disabling and persistent serious adverse events'(Health Canada) in patients using FQs. Appropriate clinical caution should be exercised in the prescribing of FQs. Common overuse seems to occur in the treatment of uncomplicated community-acquired pneumonia and cystitis, despite recommendations to use other antimicrobial agents as first-line treatments.
['Kelly|Len|L|', 'Schreiber|Yoko S|YS|', 'Hopko|Josh|J|', 'Kirkwood|T|T|', 'Kattini|Ribal|R|', 'Poirier|Denise|D|', 'Madden|Sharen|S|']
D000328:Adult D016907:Adverse Drug Reaction Reporting Systems D000900:Anti-Bacterial Agents D024841:Fluoroquinolones D006801:Humans D057970:Inappropriate Prescribing D008297:Male D008875:Middle Aged D010818:Practice Patterns, Physicians' D000067490:Prescription Drug Overuse D012424:Rural Population D055815:Young Adult
fluoroquinolone rural Antibiotic