Circumstances of the ambulatory prescription of quinolones in Urology and opportunities for intervention.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Antimicrobial stewardship programmes (AMSP) seldom focus on ambulatory prescribing. Our AMSP primarily supervises in-hospital prescribing, but as we aim to include the ambulatory setting, we sought opportunities for intervention on ambulatory quinolone prescription. MATERIALS AND METHODS: We selected the prescriptions made by urologists during 2018 for analysis, and manually checked them for adequacy. RESULTS: We analyzed 237 prescriptions. Of 136 therapeutic prescriptions, 18.4% had no reported diagnosis and 31.6% had no reported symptoms. Most patients (60.3%) did not have any urinalysis or urine culture; among those who had, 27.7% had a urinalysis not suggestive of urinary tract infection and 67.4% had a positive culture, 83.9% of which had a suitable oral alternative to quinolones. Antimicrobial therapy was not indicated in 13.9% of cases; when it was, quinolones were considered inadequate in 67.8% of cases. Incorrect duration was found in 51.1% of cases. Forty-six prescriptions were made for prophylaxis; all of these were considered inadequate. CONCLUSION: We found a high prevalence of inadequate ambulatory quinolone prescriptions in Urology. Many followed incomplete recordings, lack of laboratory use, or inattention to alternatives. Treatment duration and quinolone choice were frequently inadequate. Quinolone prescribing for prophylaxis was always considered inadequate. These prescribing errors could serve as a starting point for future interventions.