title: The appropriateness of oral fluoroquinolone-prescribing in the long-term care setting.
abstract: OBJECTIVE
  To evaluate the appropriateness of ciprofloxacin-prescribing in the long-term care setting.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A large academically oriented long-term care facility.
  
  
  METHODS
  Institutionalized elderly patients with a mean age of 88 years.
  
  
  METHODS
  One hundred orders were randomly selected for review from all ciprofloxacin orders initiated over a 3-year period. Criteria for appropriateness of ciprofloxacin-prescribing were developed based on a comprehensive review of the medical literature. Evaluation of appropriateness of prescribing was based on the indication for therapy and the availability of more effective and/or less expensive alternative antibiotic regimens. Only information available to the physician at the time of the order was used to judge appropriateness. Abstracted medical records were evaluated independently by a geriatrician and an infectious diseases specialist.
  
  
  RESULTS
  With respect to site of infection, the urinary tract accounted for 43% of all ciprofloxacin orders; the lower respiratory tract, 28%; and skin and soft-tissue infections, 17%. Only 25% of orders were judged appropriate. Twenty-three percent of orders were judged less than appropriate based on indication, and 49% due to the availability of a more effective and/or less expensive alternative antibiotic choice. There was insufficient information in the medical record to judge 3% of the orders.
  
  
  CONCLUSIONS
  These results indicate less than optimal prescribing of oral fluoroquinolones in the long-term care setting, with potential consequences including the development of resistant bacterial strains and increased health care costs.
authors.affiliation: Harvard Medical School, Boston, MA.
authors.forename: T D
authors.initials: TD
authors.lastname: Pickering
authors.forename: J H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: D
authors.initials: D
authors.lastname: Zaleznik
authors.forename: J P
authors.initials: JP
authors.lastname: Noonan
authors.forename: J
authors.initials: J
authors.lastname: Avorn
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002939:Ciprofloxacin / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000592:standards*; D014481:United States
chemical_list: D002939:Ciprofloxacin