C4d Prescribing Changes Following Revised Treatment Guidelines for Gonorrhea: An Interrupted Time Series Analysis

Wednesday, March 10, 2010: 11:15 AM
International Ballroom E/F (M2) (Omni Hotel)
Deborah Dowell, MD1, Lin H. Tian, MD, MS1, Jeffrey A. Stover, MPH2, Jennifer A. Donnelly, BS3, Summer Martins, MPH4, Emily Erbelding, MD, MPH5, Raul Pino, MD6, Hillard Weinstock, MD, MPH1 and Lori Newman, MD1, 1Division of STD Prevention, CDC, Atlanta, GA, 2Division of Disease Prevention, Virginia Department of Health, Richmond, VA, 3Colorado Department of Public Health and Environment, Denver, CO, 4STD and HIV Section, Minnesota Department of Health, St. Paul, MN, 5Baltimore City Health Department, Baltimore, MD, 6Connecticut Department of Public Health, Hartford, CT

Background: Gonorrhea, the second most common notifiable disease in the United States, may cause infertility and facilitate HIV transmission. Antimicrobial resistance limits treatment options for gonorrhea. Increasing fluoroquinolone resistance prompted CDC to stop recommending fluoroquinolones for gonorrhea treatment in April 2007.

Objectives: Evaluate the impact of revised national treatment recommendations on fluoroquinolone use in different geographic areas and practice settings.

Methods: We reviewed all gonorrhea cases treated from July 2006-May 2008 in 10 counties or independent cities reported by five local or state health departments participating in the STD Surveillance Network (SSuN): Baltimore City, Connecticut, Colorado, Minnesota, and Virginia. Using Interrupted Time Series Analysis (ITSA) with biweekly time intervals, we evaluated the impact of revised recommendations overall, by area, and by practice setting.

Results: Among 16,126 cases, 15,669 included treatment information. Of these, 31% were reported from STD clinics, 23% from primary care providers, 25% from emergency rooms (ERs) or hospitals, and 22% from other or unknown settings. After CDC released revised guidelines, fluoroquinolone use decreased 22% overall (p<0.0001), 8% in Baltimore (p=0.18), 48% in Colorado (p<0.0001), 19% in Connecticut (p<0.0001), 11% in Minnesota (p<0.0001), 28% in Virginia (p<0.0001), 29% among STD clinic providers (p<0.0001), 17% among primary care providers (p<0.0001), and 11% among ER/hospital providers (p=0.004).

Conclusions: Fluoroquinolone use decreased following release of revised national guidelines. Prescribing changes varied by area, and fluoroquinolone use decreased by a greater magnitude in STD clinics than in other settings.

Implications for Programs, Policy, and/or Research: Local public health communications to providers may explain some differences in fluoroquinolone use. Greater changes in STD clinics may reflect communication with governmental health departments regarding revised guidelines and/or coordinated impact from changes in common protocols. Additional mechanisms to influence prescribing among primary care, ER, and hospital providers are needed.