Patterns of Fluoroquinolone Prescribing at a Tuberculosis Hospital

BACKGROUND: Texas Center for Infectious Disease is a hospital that specializes in the treatment of tuberculosis (TB). Fluoroquinolones (FQ) play a vital role in the management of TB. FQ are used in patients with drug-resistant TB, intolerance to first line TB medications, extensive disease, elevated liver function tests (LFT) or a combination of these factors. Reasons for switching from one FQ to another, as well as duration of treatment prior to switching were retrospectively reviewed. METHODS: All orders for FQ from January 1, 2012 to December 31, 2016 were reviewed. Data collected included FQ start/stop dates and indication for use. If a switch was made from one FQ to another, the reason for the switch and the duration of treatment prior to switching was collected. RESULTS: 195 patients had orders for FQ. Indications for use included drug-resistant TB 72 (34.8%), elevated LFT 70 (33.8%), extensive disease 27 (13%), isoniazid (INH) or rifampin (RIF) intolerance 22 (10.6%), treatment failure 7 (3.4%), other reasons 5 (2.4%), and drug reaction with eosinophilia and systemic symptoms (DRESS) 4 (1.9%). There were 12 patients with more than one indication for FQ use. For those patients with drug-resistant TB, 42 (58.3%) had multidrug-resistant TB, 19 (26.4%) INH-resistant TB, 5 (6.9%) pre XDR-TB, 4 (5.6%) RIF-resistant TB, and 2 (2.8%) extremely drug-resistant TB (XDR-TB). Levofloxacin (LVF) was used as the initial FQ in 96 (49.2%) and moxifloxacin (MOX) in 99 (50.8%) patients. There were 69 switches in 51 patients from one FQ to another, 44(63.8%) from LVF to MOX and 25 (36.2%) from MOX to LVF. The most common reason for switching from LVF to MOX was arthralgias in 28 (63.6%) and from MOX to LVF were elevated LFT in 8 (32%) and gastrointestinal intolerance in 7 (28%). The mean duration of treatment prior to switch from LVF to MOX was 70.3 days and from MOX to LVF was 61.3 days. CONCLUSION: The most common reasons for FQ use were drug-resistant TB and elevated LFT. There was no significant difference between the frequency of use of LVF and MOX as the initial FQ. More patients were switched from LVF to MOX. The most common indication for switching from LVF to MOX was arthralgias and from MOX to LVF was elevated LFT. The time until development of adverse reactions was longer for LVF than for MOX. DISCLOSURES: All authors: No reported disclosures.