Fluoroquinolone prescribing in Taiwan, 2000 to 2010

[[abstract]]Purpose: The Taiwan Surveillance of Antimicrobial Resistance showed emergence and increasing fluoroquinolone (FQ) resistance in many important pathogens in Taiwan, including Escherichia coli, Streptococcus pneumoniae, Haemophilus influenzae, and other species, which may indicate common selective pressure exerted by increased antibiotic use. This study describes changes in FQ usage in Taiwan. Methods: This retrospective study determined the prescriptions of FQs from 2000 to 2010 using the sampling database from the National Health Insurance. Prescriptions of amoxicillin were used for comparison. Indications of prescriptions were based on International Classification of Diseases, Ninth Revision, Clinical Modification. The clinical characteristics of patients for whom FQs were prescribed were analyzed. IMS was used to estimate the amount of self-paid or inventory FQs. Results: Oral FQs in the outpatient department accounted for 84.6% of all FQs prescribed. Compared to oral amoxicillin, the prescription of oral FQs increased in recent years (odds ratio 1.089, 95% confidence interval 1.084-1.094). Non-US FDA indications accounted for 56.5% of all prescriptions. Respiratory tract, urinary tract, intra-abdominal and gastrointestinal infections accounted for 90% of approved indications. The specialties that most FQ prescribing occurred were otorhinolaryngology and family practice. Economic considerations, over the counter use, and treatment guideline recommendations are factors that cannot be included in this model and are our limitations. Conclusions: FQ resistance occurred concurrent to increased prescription of FQs. Restriction of oral FQ use may be necessary to halt this trend of drug resistance