An interventional program to improve antibiotic use

Ann Pharmacother. 2003 May;37(5):646-51. doi: 10.1345/aph.1C166.

Abstract

Background: Large volume and often inappropriate use of specific antimicrobial agents increase selective pressure for emergence of resistant bacteria and place strain on the pharmacy budget.

Objective: To initiate a multidisciplinary program designed to align intravenous vancomycin and fluoroquinolone prescribing practices with guidelines for appropriate use of these agents.

Methods: A multidisciplinary, prospective interventional program was implemented to encourage early discontinuation of inappropriate vancomycin and fluoroquinolone therapy and decrease inappropriate duplicative gram-negative coverage using fluoroquinolones. A computerized review was performed for patients receiving intravenous vancomycin and fluoroquinolones for 1998 in a Veterans Affairs Medical Center. In June 1999, guidelines were disseminated and an interventional program was initiated, with a monthly conference for medical residents regarding antimicrobial resistance and local hospital practices. Concurrently, a prospective review of new orders was assessed by the clinical pharmacist and interventions performed when inappropriate use occurred.

Results: The interventional program was successful in reducing unnecessary duplicative gram-negative coverage with intravenous fluoroquinolones by 26% (p < 0.001) from 1998 to 2001. Overall, a 43% reduction in the number of courses of intravenous fluoroquinolones was seen during these 4 years. Courses lasting >5 days were reduced by 22% (p < 0.001). Vancomycin prescriptions deemed inappropriate that were administered >5 days were reduced by 16% (p < 0.001) during the same time period. The interventions performed by the clinical pharmacist were deemed successful, with a 76% acceptance rate by providers.

Conclusions: Education of physicians through monthly conferences and personal interventions resulted in an increase in appropriate empiric antibiotic use, a decrease in the duration of inappropriate use, and a decrease in duplicate gram-negative coverage.

MeSH terms

  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Infective Agents / therapeutic use
  • Drug Costs / statistics & numerical data
  • Drug Prescriptions / statistics & numerical data
  • Drug Resistance, Bacterial
  • Drug Utilization / statistics & numerical data*
  • Drug Utilization Review
  • Education, Medical, Continuing / methods*
  • Fluoroquinolones
  • Health Services Misuse / statistics & numerical data
  • Hospitals
  • Humans
  • Physicians / standards
  • Practice Guidelines as Topic
  • Pseudomonas Infections / drug therapy
  • Pseudomonas aeruginosa / drug effects
  • Vancomycin / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Fluoroquinolones
  • Vancomycin