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An audit of fluoroquinolone prescription in a paediatric hospital

Abstract number: O93

Yang Z.T., Zahar J-R., Mechai F., Postaire M., Blanot S., Balfagon-Viel S., Lecuit M., Nassif X., Lortholary O.

Objectives: To evaluate the prescription of fluoroquinolones (FQ) for pediatric infections.

Methods: An audit of FQ prescription was conducted between 1st December 2007 and 30th June 2008 in Necker-Enfants Malades University hospital in Paris. Children admitted and receiving systemic FQ were included in the study. Descriptive data concerning patients' characteristics (immune status, cystic fibrosis), the present FQ regimen (drug, indication and bacteriologic findings, justification for use, concomitant drugs) were evaluated by 3 experts of infectious disease and 1 pharmacist. Statistical analysis was performed using Epi info version 6, CDC Atlanta.

Results: 52 oral (53.1%) and 46 (46.9%) intravenous FQ prescriptions were collected. Prescriptions mainly originated from general pediatric wards (25.4%), immuno-hematology department (20.4%), intensive care units (12.2%) and cardiac surgery unit (11.2%).

Among these 98 children, median age was 10 years. 45 (45.9%) had an underlying condition, CF (21.4%) and immune deficiency such as neutropenia (12.2%), use of any immunosuppressive agent (12.2%). The indications for FQ prescription to patients with CF (21) were bronchopulmonary P. aeruginosa infection or prophylaxis (20/21). Among 77 patients without CF, of which only 14 had P. aeruginosa infection, the main infection sites were bronchopulmonary (25), post-operative (10), urinary tract (8), gastrointestinal tract (6), septicemia (6), bone or joint (4) and cerebral (4), endocarditis (2). 61 (62.2%) infections were nosocomially aquired. 22 of the 35 community acquired were health care associated. Bacteriological confirmation was isolated in 60 (61.2%) patients.

52 prescriptions were considered as adequate FQ use, of which 36 were mandatory, 16 as adequate indication based on clinical and/or microbiologic findings. 35 of 46 inadequate prescriptions might have had an alternative antibiotic to FQ, 11 were unnecessary. Median ciprofloxacine dosage was 20 mg/kg/24 h. 46 patients received an excessive dose, while 7 had insufficient treatment. 87.8% patients had a concomitant drug use.

Appropriate prescription of FQ was associated with P. aeruginosa infection in CF patients (p = 0.0001, OR = 12.67, 95% CI 2.52–86).

Conclusion: More than a half FQ prescription in pediatric patients was adequate and mandatory. The problems of inadequate prescriptions focus on the dosage and that FQ could be replaced by an alternative antibiotic. Appropriated prescriptions were associated with P. aeruginosa infection in CF patients.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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