Powerful Antibiotics Frequently Prescribed for Discharged Patients

Even as hospitals try to cut back on prescribing powerful antibiotics for their patients, many of those patients still head home with prescriptions for those same drugs.

Michigan hospitals that are actively trying to reduce use of fluoroquinolones were twice as likely to discharge patients with a new prescription for one of the powerful antibiotics, a new study shows.

One-third of the patients studied in the University of Michigan study received a fluoroquinolone prescription at the end of their hospital stay, despite the fact that current guidelines call for restricted use due to side effects.

In the 48 Michigan hospitals in the study, discharge-related prescriptions accounted for two-thirds of the entire fluoroquinolone supply prescribed to the nearly 12,000 patients treated for pneumonia or urinary tract infections, and 42% of all antibiotics prescribed at discharge.

"Fluoroquinolone antibiotics are easy to use, but carry a lot of risk for patients and society at large," Valerie Vaughn, MD, lead author of the study and a hospital medicine specialist at Michigan Medicine, said in a media release.

"These results show we need to focus on not just their use in hospitals, but also in the prescriptions that we send patients home with. Discharge prescribing is a big loophole," she said.

Fluoroquinolones include name-brands like Cipro and Levaquin as well as generic antibiotics whose names end in "floxacin." They have been linked to the rise of drug-resistant organisms and Clostridiodes difficile.

They've also been linked to ruptures of Achilles tendons, to dangerously low blood sugar levels in people with diabetes, and to mental health problems including disorientation and delirium.

The study, published in Clinical Infectious Diseases, used data from the Michigan Hospital Medicine Safety (HMS) Consortium.

The new study focuses on pneumonia and UTI because the two conditions account for almost half of antibiotic use in hospitals. Most patients with these conditions are cared for by hospitalists or general internists, rather than infectious diseases specialists who mainly focus on the most serious cases.

In all, more than 10% of patients in the study were switched to a fluoroquinolone antibiotic when they were discharged.

Vaughn said fluoroquinolones can treat a broad spectrum of infectious organisms, and can be used in patients who are allergic to penicillin. They also come in pill form, rather than needing to be delivered intravenously, which makes them much more attractive for discharge prescriptions.

But if patients are getting through their hospitalization without them, then they're likely not the right choice for treatment after they leave the hospital, she said.

Fourteen of the hospitals in the study had specific measures in place to require review of fluoroquinolone prescriptions during hospitalization.

In these hospitals, more than 78% of the supply of fluoroquinolones was prescribed at discharge, compared with 68% of the supply for the other 34 hospitals, nearly all of which had antimicrobial stewardship programs but didn't put special emphasis on fluoroquinolones.

The study authors speculate that while pharmacists and infection prevention specialists are keeping an eye on in-hospital prescribing, they don't have access to prescriptions written at discharge. Electronic health record systems track both inpatient and discharge medications, but they are often in separate sections of the record.

Since the data were shared, several hospitals in the consortium have begun paying special attention to discharge prescribing of fluoroquinolones, and others are preparing to.