Can we reduce the use of third-generation cephalosporins and fluoroquinolones for lower respiratory tract infections in the emergency department?

被引:1
作者
Montassier, E. [1 ,2 ]
Lim, T. -X. [3 ]
Goffinet, N. [1 ]
Le Conte, P. [1 ]
Potel, G. [1 ,2 ]
Batard, E. [1 ,2 ]
机构
[1] CHU Nantes, Urgences, 1 Pl Alexis Ricordeau, F-44000 Nantes, France
[2] Univ Nantes, Fac Med, Therapeut Clin & Expt Infect EA3826, F-4400 Nantes, France
[3] Ctr Hosp Challans, Urgences, F-85302 Challans 01, France
来源
ANNALES FRANCAISES DE MEDECINE D URGENCE | 2013年 / 3卷 / 02期
关键词
Pneumonia; Acute exacerbation of COPD; Fluoroquinolones; Third-generation cephalosporin;
D O I
10.1007/s13341-012-0273-y
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: To assess the frequency of prescription of third-generation cephalosporins (3GC) and fluoroquinolones for lower respiratory tract infections, and the avoidable part of these prescriptions. Procedure: Retrospective series of 88 adult cases of community-acquired pneumonia and acute exacerbation of chronic obstructive pulmonary disease (COPD). Compliance with national guidelines was assessed. Furthermore, prescriptions that complied with guidelines were deemed justified if at least one criterion was present: allergy or intolerance to penicillins, failure of penicillin, penicillin therapy in the previous month, suspected urinary tract infection, admission in intensive care unit, and only for quinolones, suspected legionellosis. Avoidable prescriptions included prescriptions that did not comply with national guidelines and prescriptions that complied with guidelines but were not justified. Avoidable prescriptions of 3GC and fluoroquinolones may be replaced by amoxicillin/clavulanate. Results: Median age was 79 (72 pneumonia, 16 acute exacerbation of COPD). Thirty-two (36% [27-47%]) and 10 patients (11% [6-20%]) received 3GC and fluoroquinolone respectively. The majority of prescriptions of fluoroquinolone (86% [47-99%]) and 3GC (93% [77-99%]) complied with national guidelines. However, 52% [34-69%] of 3GC prescriptions and 57% [25-84%] of quinolone prescriptions were avoidable. Conclusion: Third-generation cephalosporins and fluoroquinolones are frequently prescribed for lower respiratory tract infections in the ED. Half of these prescriptions may be avoided.
引用
收藏
页码:74 / 78
页数:5
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