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. 2019 Aug 15;1(2):100019.
doi: 10.1016/j.infpip.2019.100019. eCollection 2019 Jun.

Restriction-free antimicrobial stewardship initiative targeting fluoroquinolone reduction across a regional health-system

Jacinta Chin  1 , Sarah B Green  1 , Lacie J McKamey  1 , Michael D Gooch  1 , Ryan W Chapin  1 , Alyssa P Gould  1 , Stephanie F Milliken  1 , Lisa M Blanchette  1
Affiliations

Restriction-free antimicrobial stewardship initiative targeting fluoroquinolone reduction across a regional health-system

Jacinta Chin et al. Infect Prev Pract. .

Abstract

Background: Fluoroquinolone (FQ) antibiotics have become a target of many antimicrobial stewardship programmes. Multiple post-marketing warnings from the Food and Drug Administration caution against use of this drug class for certain infections due to risk of harmful adverse effects outweighing benefit. Commonly employed strategies to affect antibiotic prescribing can be restrictive and without improvement in overall antibiotic appropriateness or decrease in collateral damage.

Aim: To develop a strategy for sustainable optimization of FQ antibiotics.

Setting: Multi-state health-system of 14 hospitals and medical centers.

Methods: The health-system antimicrobial stewardship program identified the opportunity to improve FQ utilization. In collaboration with our data and analytics team, specific targets of FQ use in pneumonia and chronic obstructive pulmonary disease were established. Face-to-face provider education and prospective audit and feedback were the mainstays of the campaign. Enhancements to the electronic medical record to support the initiative were also implemented.

Findings: There was an overall decrease in FQ utilization by 56.9%. For pneumonia use of FQs decreased from 16.4% to 8.1% and in COPD changed from 29.6% to 9.7% over the same time period.

Conclusions: A non-restrictive FQ optimization initiative based on education and feedback decreased both FQ consumption and total antibiotic use across a large multi-hospital health-system.

Keywords: Antimicrobial stewardship; Fluoroquinolones; Health-system; Pharmacist.

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Figures

Figure 1
Figure 1
Timeline of individual interventions and corresponding system-wide FQ consumption.
Figure 2
Figure 2
FQ utilization within pneumonia and COPD diagnosis-related groups.
Figure 3
Figure 3
Overall antibiotic and FQ consumption before and during the initiative period. Of note, additional facilities were added in June 2016 which contributed to approximately 6% of the health-system days of therapy.
See this image and copyright information in PMC

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