Evaluation of Fluoroquinolone Use in Hospice Patients (GP783)

Abstract

• Recall risks associated with fluoroquinolone use in hospice patients• Identify a process for balancing risk vs benefit of fluoroquinolones in hospice patients. Since 2004, the Food and Drug Administration (FDA) has released eight safety communications regarding serious adverse effects associated with fluoroquinolones, including peripheral neuropathy, tendonitis/tendon rupture, worsening of myasthenia gravis, central nervous system effects (confusion, hallucinations), hypoglycemia, QTc prolongation, and aortic tear/rupture. An FDA Boxed Warning was issued to reserve use of fluoroquinolones for patients with no alternative treatment options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, and uncomplicated urinary tract infections. Despite the warnings and risks, fluoroquinolone antibiotics are commonly prescribed. To evaluate risk factors for serious adverse effects in hospice patients taking fluoroquinolones. Retrospective chart review of a national hospice pharmacy provider was completed. Decedents with pharmacy claims for fluoroquinolones during January 2019 were reviewed. Demographics collected included hospice diagnoses, presence of cardiac disease or hypertension medications, concomitant corticosteroids, QTc prolonging medications, sex, and fluoroquinolone claims within 14 days of death. Nearly 15% (n=10,719) of decedents had at least one antibiotic claim during the review period, average age 80.1 years. Over 24% of patients filled the fluoroquinolone within 14 days of date of death. Fluoroquinolones comprised 24.4% of claims (n=4,651), the largest percentage of all antibiotic claims. Fluoroquinolone prescriptions were predominantly ciprofloxacin (51.4%) and levofloxacin (48.6%). The top 5 hospice diagnoses in the study population were cardiac (21.4%), dementia (21.3%), pulmonary (18.3%), cancer (15.6%), and stroke (8.7%). Known QTc prolongation risk factors included female patients (60.2%), age over 65 years (86.0%), and concomitant QTc risk medication use (51.5%). Additional FDA fluoroquinolone risk factors were present: hypertension (64.1%), concomitant corticosteroid use (22.9%). Our population review illustrates high utilization of fluoroquinolones in patients with multiple risk factors for serious adverse events. Increased awareness of patient risk factors identified by FDA warnings may help promote safer antibiotic prescribing for hospice patients.