Limiting Fluoroquinolone Use Linked to Less C Diff

Curbing Antibiotics Tied to Britain’s Drop in C. Diff

This looked at the impact of fluoroquinolone prescribing restriction in Britain and found a reduction in C. Diff occurrance as well as fluoroquinolone resistant organisms. Generally antibiotic rotation is not recommended as a stewardship intervention but there seem to be ever more reasons to move away from prescribing FQs first line in general.

Thankfully we don’t have a high rate of nosocomial c diff at my institution but anecdotally I have not noticed a particular increased incidence secondary to any particular antibiotic or antibiotic class. Interestingly if you delve into the full paper, it mentions:

Hospital cephalosporin and fluoroquinolone prescribing were also positively associated with incidence of C difficile infection (CC=0·73, 0·15 to 0·86, and 0·62, −0·09 to 0·81; appendix), but associations were estimated much less precisely given the much smaller population (approximately 1% of England). Positive associations were also observed between C difficile infection decline and decline in extended spectrum penicillins (0·84, 0·24 to 0·90) and beta-lactamase-resistant penicillins (0·67, −0·04 to 0·81; appendix).

The paper was only fully powered it seems for fluoroquinolones because their prescribing was actually restricted. The interesting part is they correlated with FQ-sensitive and FQ-resistant strains of c-diff, and once they reduced FQ prescribing, the only c-diff infections were with FQ-sensitive c. diff strains. This is a bit confusing to me as we never used a FQ to treat c-diff; I had no idea any of the c. diff strains were sensitive.

Conclusion? I’m still not sure which abx are the worst for causing c diff (surely you would even need to specific specific cephalosporins rather than the whole class??) so I’ll stick to my current principle, which is try to use less of all antibiotics in the first place.