A new analysis has revealed that fluoroquinolone medications rank as the top choice for treating uncomplicated urinary tract infections (UTIs) in women. The authors of the study, which was published online August 2nd in Open Forum Infections Diseases, voiced concern that this over-reliance could be contributing to greater fluoroquinolone resistance.
The authors of the study utilized National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey datasets from 2002 to 2011 to identify outpatient visits for women aged 18 years and older diagnosed with uncomplicated UTIs. Around 80% of these visits resulted in an antibiotic prescription.
Fluoroquinolones, a class of medications that includes Levaquin, Avelox and Cipro, were the most-frequently prescribed (49%), followed by sulfonamides (27%) and nitrofurantoin (19%). Patients over the age of 70, those treated by internists rather than family practitioners, and those from the West rather than Northeast were the most likely to receive a fluoroquinolone antibiotic.
The authors noted that the increased use of fluoroquinolone antibiotics to treat uncomplicated UTIs has coincided with an increased incidence of fluoroquinolone resistance among urinary tract pathogens.
“Additional studies are needed to determine the most effective drivers to optimize prescribing for UTI in ambulatory care settings,” the researchers concluded. “Providers and practices should consider assessing antibiotic selection for UTI as a potential target for antibiotic stewardship implementation.”
Fluoroquinolone antibiotics are approved to treat a number of serious bacterial infections, including pneumonia and certain sexually transmitted diseases. However, in May the U.S. Food & Drug Administration (FDA) warned against their use for most cases of sinusitis, bronchitis and uncomplicated UTIs, as their risks generally outweigh their benefits when other treatment options are available. The FDA warning followed an agency review that suggested fluoroquinolones could cause side effects involving the tendons, muscles, joints, nerves and central nervous system. These complications are potentially permanent and can occur together.
The May warning was only the latest from the FDA to focus on fluoroquinolone antibiotics. In August 2013, the agency ordered the drugs’ manufacturers to modify label information regarding their potential to cause a serious nerve disorder called peripheral neuropathy. While mention of the condition had been added to the prescribing information in 2004, the FDA determined that the labels did not reflect the possible rapid onset of the condition, or the potential for permanence.
In 2008, a black box warning – the FDA’s strongest possible safety alert – was added to the labeling of all fluoroquinolone antibiotics regarding an association with serious tendon injuries, including tendon ruptures.