Yu J, McKenna V, Dumyati G, Lubowski T, Carreno J. 1105. Statewide, Retrospective, Cohort Study of Medicare Part B Quinolone Prescribing for Cystitis in 2016–2017.
Open Forum Infect Dis 2019. [PMCID:
PMC6811017 DOI:
10.1093/ofid/ofz360.969]
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Abstract
Background
Quinolones (FQ) are no longer recommended as first-line therapy for cystitis. In 2016, the FDA released a safety communication advising FQ restriction in the treatment of uncomplicated urinary tract infection unless no other options are available. However, little is known about the frequency of FQ (FFQ) prescribing in older adults (OA) receiving antibiotics for cystitis in New York State (NYS). This study compared the FFQ prescribing in OA receiving antibiotics with a diagnosis of cystitis in NYS between 2016 and 2017.
Methods
Retrospective, cohort study of (NYS) Part B Medicare fee-for-service beneficiaries in 2016 and 2017 with diagnosis codes for cystitis. All antibiotics prescribed ≤ 3 days after visit were analyzed. FQ were defined as ciprofloxacin, gemifloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin. County-wide data were aggregated into regional data per NYS Department of Health Population Health Improvement Program categories, but New York City counties were not grouped. FFQ was analyzed at the state and regional level and was defined as the total # of FQ prescriptions / total # of antibiotic prescriptions with the diagnostic code for cystitis. χ 2 test and Risk Ratios (RR = 2017 FFQ/2016 FFQ) were used to compare 2016 and 2017 FFQs for the state and for each region using SAS v 9.3 (α = 0.05).
Results
50,658 antibiotic prescriptions were written for Medicare beneficiaries diagnosed with cystitis in NYS. The statewide FFQ decreased by 14% from 35.9% in 2016 to 31.0% in 2017 (RR: 0.86 [95% CI: 0.84 – 0.88], P < 0.001). FFQ decreased significantly in 11 of 15 regions (P < 0.05, Figures 1 and 2). The median (IQR) FFQ RR for the regions was 0.83 (0.81, 0.87) (Figure 3). The regions (RR [95% CI]) with the largest decrease were Bronx (0.78 [0.67,0.91]), Finger Lakes (0.80 [0.71,0.89]) and Central New York (0.81 [0.72,0.91]). Limited or no changes were observed in Brooklyn (1.01 [0.94, 1.09]), Queens (0.97 [0.88, 1.06]) and Staten Island (0.95 [0.79, 1.13]).
Conclusion
On a statewide level, there were significant decreases in FFQ for cystitis in older adults in 2017 compared with 2016. Nevertheless, up to a third of cystitis prescription were for FQ. Future studies should evaluate the appropriateness of FQ for cystitis in OA.
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Disclosures
All authors: No reported disclosures.
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