Clinical audit of ciprofloxacin use in adults admitted to hospital with gastroenteritis

We audited the use of ciprofloxacin, before and after the introduction of simple guidelines, in adults admitted to a regional infections diseases unit with presumed gastroenteritis. The case notes of 128 consecutive adult admissions over 6 months in 1993 were reviewed and a comparable group of 125 adults in 1994 were prospectively followed. The discharge diagnosis was infective gastroenteritis in 73% of the 1993 admissions and 75% of the 1994 admissions, of whom 42% and 51% had confirmed bacterial enteropathogens. The 1994 cohort appeared to be more ill, with longer duration of symptoms prior to admission, more patients with profuse diarrhoea prior to admission, and longer mean duration of hospital stay. The proportion of patients with a discharge of gastroenteritis who received ciprofloxacin did not change (64% in 1993, 67% in 1994) but the proportion of these patients who were subsequently found to be culture-positive rose from 54% to 68%. The proportion of patients receiving intravenous ciprofloxacin fell from 20% to 10% and the total number of doses (intravenous and oral) fell from 1027 in 1993 to 768 in 1994, with cost savings of £1465 over 6 months. The benefits and drawbacks of empirical use of ciprofloxacin are discussed. Our audit suggests that simple clinical guidelines can assist in identifying suitable patients for empirical antimicrobial therapy, and result in substantial cost savings.