AN AUDIT OF CIPROFLOXACIN USE IN A DISTRICT GENERAL-HOSPITAL

An audit of ciprofloxacin use at Southmead Hospital, Bristol was carri ed out for forty patients treated in early 1992 employing a modified D elphi technique with six assessors. Most patients assessed (20/40, 50% ) had urinary tract infections (UTIs), 5/40 (12.5%) had chest infectio ns, 4/40 (10%) had bacterial gastroenteritis and 3/40 (7.5%) had eithe r bacteraemia or infection following an orthopaedic procedure. A likel y bacterial pathogen was isolated from 32/40 (80%) of patients; 14/32 (44%) had Pseudomonas aeruginosa infections and from the remainder Ent erobacteriaceae including Salmonella spp. (non-typhoid) were cultured. Oral therapy with ciprofloxacin was used in 37 (93%) of the 40 patien ts, and the three others received iv treatment. In 21/35 (60%) of pati ents where an assessment was made by majority scoring, a quinolone was felt to be clinically justified, A quinolone was least likely to be t hought justified if the patient had a chest infection. The assessors h ad few concerns about the effectiveness or toxicity of ciprofloxacin b ut for 41% (14/34) of patients, where there was a majority opinion, a cheaper alternative was felt to be available; most of these patients h ad hospital-acquired UTIs caused by Enterobacteriaceae. The duration o f therapy was felt to be too long in 35% (10/29) of patients, mainly b ecause of prolonged treatment of UTIs. In some cases of P. aeruginosa infection the assessors would have used higher doses than those prescr ibed. Ciprofloxacin was the quinolone of choice in 24/32 (75%) of asse ssable cases. Norfloxacin was chosen to treat UTI due to multi-resista nt Enterobacteriaceae in 6.2% (2/32) cases. Ciprofloxacin was felt to be more suitable than ofloxacin, especially for patients with P. aerug inosa infection, and there were doubts about the use of ofloxacin in g astroenteritis as it is not licensed for this indication in the UK.