Clinical research study
Impact of a Fluoroquinolone Restriction Policy in an Elderly Population

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Abstract

Background

In light of growing concerns of bacterial resistance to fluoroquinolones, the province of Ontario instituted a fluoroquinolone restriction policy in March of 2001. The objective of this study was to examine the immediate impact of this policy on the rates of antibiotic prescription use and infectious disease-related hospitalizations among elderly individuals who are dispensed antibiotics.

Methods

An interrupted time series analysis was conducted from January 1, 1994, to March 31, 2002, using administrative health care databases covering more than 1.4 million residents of Ontario, Canada, aged 65 years and older. Population rates of antibiotic use and infectious disease-related hospitalizations within 4 weeks after an antibiotic prescription were examined using interventional autoregressive integrated moving average models.

Results

Immediately after the introduction of the fluoroquinolone policy, fluoroquinolone prescription rates decreased to approximately 70% of expected rates (P < .01). Approximately 30% higher than expected use of sulfonamide (P = .01) and urinary anti-infectives (primarily nitrofurantoin and trimethoprim; P < .01) were observed within 1 year after policy implementation. No significant changes in the use of any other groups of antibiotics were observed. Although no significant changes in the rates of overall infection-related hospital admissions among antibiotic users were observed, the rate of hospital admission for gastrointestinal infections was 32% lower than expected in the 1 year after the policy change (P < .01). The hospital admission rate for urinary tract infections was approximately 8% higher than expected (P < .01).

Conclusions

These findings suggest that formulary restrictions to fluoroquinolones can be implemented effectively to decrease use among an elderly population without adverse impact on hospital admission rates.

Section snippets

Study Design

We conducted a population-based cross-sectional time series analysis from January 1, 1994, to March 31, 2002, using administrative health care databases covering the entire population of 1.4 million residents of Ontario, Canada, aged 65 years and older. This time period was divided into 33 quarterly intervals. Ontario’s elderly population has universal access to prescription drugs, hospital care, and physician services. This research study was approved by the Ethics Review Board of Sunnybrook

Results

Antibiotic use varied by season, with peak use during the first quarter of each year (ie, January to March) and lowest use during the third quarter of each year (ie, July to September). The prevalence ranged from a high of 21.6% of the elderly population (n = 283,653) during the first quarter of 1995 to a low of 14.1% of the elderly population (n = 210,196) during the third quarter of 2001. The average population per time interval was approximately 1.40 million elderly persons (standard deviation = 

Discussion

A significant reduction in fluoroquinolone use after the introduction of a formulary restriction policy aimed at all fluoroquinolones (except norfloxacin) was observed in a population 65 years and older. These reductions were accompanied by increases in the use of norfloxacin, urinary anti-infectives, and sulfonamide and combination antibiotics without any significant increases in macrolide or cephalosporin use in the 1-year after policy implementation. This is an important observation given

Acknowledgments

We acknowledge the support and advice of the Drug Programs Branch of the Ontario Ministry of Health in conducting this study.

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