Tuesday, April 18, 2017

Restrict Fluoroquinolones! Not so far fetched, But How Do We Do It Stateside?

There is mounting evidence that restricting fluoroquinolones significantly reduces C. difficile infections, particularly in the United Kingdom, as recently reported in Lancet Infectious Diseases. It is well known that fluoroquinolone use is unnecessary (>30% of the time) in hospitalized patients, as reported here in 2011.

Will this play out stateside, where restriction of antibiotics is not used as a primary C. difficile prevention measure?

If there is will there is a way. 

Fluoroquinolone restriction could be done but we would need to tackle the 'physician autonomy' ethos in US medicine. To do it right, we would need sound evidence based policies, clear education on the rationale for restricting fluoroquinolones, and, treatment pathways or alternatives to fluoroquinolone use either for empiricism or for specific diagnoses. That said, it still may not be popular.

So if anyone has been successful in restricting fluoroquinolones in a US hospital (other than the Veteran's Administration Hospitals where a top down approach seems to work), let me know. 

I am looking forward to any insights on the matter.

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