Evaluation of Levofloxacin Prescription Pattern and Appropriateness Rate in the Outpatient Setting; A Cross-Sectional Study from Iran (2018-2019)
Bayan Azizi Pharm. D.
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Sholeh Ebrahimpour Pharm. D.
Department of Clinical Pharmacy, Virtual University of Medical Sciences, Tehran. Iran.
Mohammadreza Salehi M. D.
Department of Infectious Diseases and Tropical Medicine, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Zahra Jahangard-Rafsanjani Pharm. D.
*
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran and Breast Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran.
*Author to whom correspondence should be addressed.
Abstract
Background: Levofloxacin is prescribed widely as a first-line or alternative treatment option for different infectious diseases. The inappropriate use of this agent has increased the risk of antibiotic resistance, which has convinced researchers to address this issue by designing antibiotic prescription pattern studies.
Aim: This study aimed to evaluate levofloxacin's prescription pattern and appropriateness in the outpatient setting in Iran.
Methodology: This cross-sectional study included all admitted prescriptions containing levofloxacin from October 2018 to June 2019. Data regarding the demographics, clinical and laboratory presentations, preexisting comorbidities, dose and duration of levofloxacin, and the prescribers medical specialty were collected by reviewing the patient's prescriptions or history taking. The pattern and appropriateness of prescriptions were evaluated according to the assessment tool based on accepted international guidelines.
Results: A total of 300 eligible patients (median age: 56.5 years; 56.7% male) were included in the study. Respiratory tract infections were the most common indication for levofloxacin prescription (55.6%); more than half of them were related to community-acquired pneumonia (29.6%). The inappropriateness rate for levofloxacin prescription was 55.3 %, of which 12.6% were related to community-acquired pneumonia, 9.6% skin infections, 8.4% rhinosinusitis, and 6.6% Urinary tract infection. Only 54 (18.0%) patients received levofloxacin with an appropriate indication, dose, and duration, indicating its rational use.
Conclusion: This study found that more than half of all levofloxacin prescriptions in the outpatient setting are inappropriate, contributed mainly to respiratory tract diseases. Interventions that target these health care providers are essential to improve prescribing of this valuable antibiotic.
Keywords: Levofloxacin, inappropriate prescription, antimicrobial stewardship, outpatient monitoring