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.

Keywords::

• Antibiotic resistance
• intervention
• antibiotic stewardship
• emergency department
• primary care

Acknowledgement

We thank Magne Thoresen for the statistical analysis and the primary care research group in Aust Agder for helpful guidance. This study was supported by a grant from the Family Practice Research Committee and the Norwegian Surveillance System for Antibiotic Resistance (NORM).

Declaration of interest: No conflicts of interest declared.