The appropriateness of oral fluoroquinolone-prescribing in the long-term care setting.

OBJECTIVE: To evaluate the appropriateness of ciprofloxacin-prescribing in the long-term care setting. DESIGN: Retrospective chart review. SETTING: A large academically oriented long-term care facility. PATIENTS: Institutionalized elderly patients with a mean age of 88 years. METHODS: One hundred orders were randomly selected for review from all ciprofloxacin orders initiated over a 3-year period. Criteria for appropriateness of ciprofloxacin-prescribing were developed based on a comprehensive review of the medical literature. Evaluation of appropriateness of prescribing was based on the indication for therapy and the availability of more effective and/or less expensive alternative antibiotic regimens. Only information available to the physician at the time of the order was used to judge appropriateness. Abstracted medical records were evaluated independently by a geriatrician and an infectious diseases specialist. RESULTS: With respect to site of infection, the urinary tract accounted for 43% of all ciprofloxacin orders; the lower respiratory tract, 28%; and skin and soft-tissue infections, 17%. Only 25% of orders were judged appropriate. Twenty-three percent of orders were judged less than appropriate based on indication, and 49% due to the availability of a more effective and/or less expensive alternative antibiotic choice. There was insufficient information in the medical record to judge 3% of the orders. CONCLUSION: These results indicate less than optimal prescribing of oral fluoroquinolones in the long-term care setting, with potential consequences including the development of resistant bacterial strains and increased health care costs.

The impact of livestock-farming on welsh streams: the development and testing of a rapid biological method for use in the assessment and control of organic pollution from farms.

Organic wastes from intensive agriculture are a major cause of surface-water pollution in Great Britain. There are a large number of possible sources for such pollution, and there is a need to target the efforts of pollution-control authorities to the worst-affected parts of catchments. This paper describes the development of a rapid method for the identification of polluted streams based upon the macro-invertebrate fauna. An indicator key was developed by TWINSPAN classification of data from benthic sampling at 55 sites in West Wales. The key requires assessment of the abundance of four macroinvertebrate taxa and of the extent of 'sewage-fungus' growth, all of which can be determined by examination in the field. The key can separate sites into three groups representing different levels of pollution impact as indicated by differences in biotic indices and chemical data. The system was tested successfully at a further 146 sites in West Wales resulting in the notification of 49 farms to the pollution-control authorities. Non-biologists were able to use the key efficiently after a short period of training. A further test involving 51 sites in Devon indicated that the technique may be adaptable to other parts of Great Britain. It is envisaged that indicator systems designed to suit local fauna may have a major role in a pro-active strategy developed to combat pollution from farms because they have potential advantages over more complex biological methods currently in use.