title: A simple intervention to reduce inappropriate ciprofloxacin prescribing in the emergency department.
abstract: BACKGROUND
  According to Norwegian guidelines for antibiotic use in primary care, ciprofloxacin is reserved for complicated urinary tract infections (UTI). Despite these recommendations, ciprofloxacin use has increased in Norway in recent years. We aimed to reduce inappropriate ciprofloxacin prescribing in the emergency department.
  
  
  METHODS
  An intervention study was performed by removing ciprofloxacin from the local antibiotic formulary and including a suggestion list for antibiotic use with all point of care urine dipstick testing in an emergency department. An emergency department in the neighbouring county served as the control. Prescriptions for UTI were registered 1 y prior to and 1 y after the intervention.
  
  
  RESULTS
  In the targeted emergency department, there was a significant (p < 0.0001) reduction in ciprofloxacin prescribing for cystitis, while the use of mecillinam increased (p = 0.042). In the control department, prescribing of ciprofloxacin doubled (p < 0.0001).
  
  
  CONCLUSIONS
  An intervention based on a therapy suggestion list and on limiting the availability of ciprofloxacin in the local formulary, resulted in treatment more in line with national guidelines by reducing ciprofloxacin and increasing mecillinam prescribing.
authors.affiliation: From the Institute of Health and Society, Faculty of Medicine, University of Oslo , Oslo , Norway.
authors.forename: Mark
authors.initials: M
authors.lastname: Fagan
authors.forename: Morten
authors.initials: M
authors.lastname: Lindbæk
authors.forename: Harald
authors.initials: H
authors.lastname: Reiso
authors.forename: Dag
authors.initials: D
authors.lastname: Berild
mesh_terms: D000560:Amdinocillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003556:Cystitis / Q000188:drug therapy / Q000382:microbiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008297:Male; D009664:Norway; D017410:Practice Guidelines as Topic; D011704:Pyelonephritis / Q000188:drug therapy / Q000382:microbiology; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D000560:Amdinocillin
keywords: Antibiotic resistance; antibiotic stewardship; emergency department; intervention; primary care