Inappropriate use of oral ciprofloxacin

Article Abstract:

In the United States more than $6 billion worth of various antibiotics are prescribed annually. Approximately one half of this amount is used in the treatment of outpatients by oral doses of antibiotics, or approximately one course of therapy for each medical resident per year. Nearly $1.1 billion was spent on five new and expensive products: ciprofloxacin (Cipro), norfloxacin (Noroxin), amoxicillin-clavulanate potassium (Augmentin), cefuroxime axetil (Ceftin) or cefaclor (Ceclor). These drugs are promoted because of their ease of use, decreased side effects, and convenient dosage. However, these expensive drugs are being used in many cases as first-line therapies where there is no particular advantage or where their spectrum (range of organisms killed) is inappropriate or insufficient. One example is the inappropriate prescribing pattern for ciprofloxacin. This drug was certified for use in the United States in October 1987. The drug is relatively safe, has good oral absorption, and a broad spectrum. These attributes have made it one of the most generally used antibiotics. By 1989 ciprofloxacin was the fourth most frequently prescribed antibacterial drug. Five cases of patients treated with ciprofloxacin are reported to illustrate that the drug is inappropriate for use against streptococcal and mycoplasmal infections, outpatient-acquired pneumonia, when the patient's condition requires hospitalization, or for treatment of cellulitis (tissue infections by specific gram-negative organisms). Because the drug has few important side effects, it is also prescribed when there is no infection present. However, with increasing use, the chance of side effects increases, and these are likely to be encountered more frequently. Despite inappropriate use and limitations, ciprofloxacin is a useful and powerful oral antibiotic when properly prescribed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Antibiotics, Dosage and administration, Ciprofloxacin

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The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis

Article Abstract:

Death rates during a recent New York tuberculosis outbreak appear to have been high. Obtaining timely treatment and completing treatment appear to be important factors in survival. Researchers followed up all 229 cases of tuberculosis diagnosed in New York City in April 1991. By October 1994, nearly half the patients had died. AIDS, contracting a multidrug resistant variety, failure to obtain treatment, and delay in treatment all greatly increased the likelihood of death. Among the 173 patients surviving past the recommended length of time of treatment, completing treatment reduced the chances of dying.

Patient outcomes, Mortality, Tuberculosis

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Health care as if health mattered

Article Abstract:

The important changes in the system that need to be executed in order to bring effective and maximum health care to American are discussed.

United States, Government domestic functions, Product quality, HEALTH SERVICES, Analysis, Health care industry, Quality management, Health care reform, Health policy

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