Outpatient Quinolone Use

Outpatient Quinolone Use

This broad-spectrum class sees the largest increase in utilization

Background

Quinolones include ciprofloxacin, norfloxacin, ofloxacin, and gemifloxacin, which are orally administered, and moxifloxacin and levofloxacin, which can be administered orally and parenterally. The mechanism of action is bactericidal and involves inhibiting the enzymes necessary for bacterial DNA replication. Quinolones are indicated for urinary tract infections, community-acquired pneumonia, skin infections, and prostatitis. Use of these drugs has been associated with certain side effects, most notably tendon ruptures (especially in those taking corticosteroids) but also blood sugar disturbances, neuropathy, and others.

Safer alternatives exist, but quinolones have nevertheless become the broad-spectrum drug of choice in many physician offices because of the spread of resistance to older classes. Of note, research has found that growth in new fluoroquinolones contributed most to the 1995–2002 surge in their consumption, and that more than 40% of dispensed prescriptions were for non-FDA–approved indications. This aberrant consumption and the concerns of rapidly evolving gram-negative resistance have led to local and regional restrictions in fluoroquinolone use.