Fluoroquinolone Use in an Urban Community Teaching Hospital: an Interventional Quality Assurance Study

Background: Inappropriate use of antibiotics contributes to the evolution of resistant bacterial strains and decreases the quality of medical care. 

Objective: To reduce the inappropriate use of ciprofloxacin and moxifloxacin in an urban community teaching hospital, through the implementation of a multidisciplinary antibiotics stewardship program.

Methods: This retrospective and prospective interventional quality assurance study was conducted in three phases.  During the first phase, pre-intervention, researchers observed and documented fluoroquinolone use, particularly the number of days on medication and the primary diagnosis.  In addition, researchers cross-checked the patient medical records to assess whether proper cultures and sensitivity tests were ordered and completed.  The second phase contained both educational and interventional components.  The educational component consisted of department wide distribution of literature and flyers coupled with weekly departmental meetings targeted at reinforcing the guidelines for appropriate antibiotic use.  The intervention occurred only if an improper workup was noted:  researchers telephoned the caregiver and requested a proper workup.  During the third and final phase, post-intervention, researchers observed and documented the effect of the stewardship program.  The chi square test was used for statistical analysis.

Results: 873 patients were initially included for all three phases of the study.  The mean duration for which an antibiotic was given was 6 days.  52% of patients received ciprofloxacin; 40%, moxifloxacin; and the remaining 8% were either on multiple antibiotics or excluded from the study.  During phase one, 67% of patients had proper culture and sensitivity done, compared to 68% in phase two, and 79% in phase three (p=0.003).  In phase one, 10% of patients were on the correct antibiotics, compared to 15% in phase two, and 40% in phase three (p<0.001).  The rate of follow-up comparison of patient culture results with the type of antibiotic increased from 15% in first phase to 42% in the third phase.

Conclusions: Implementation of an antibiotic stewardship program successfully improved the appropriate use of fluoroquinolones in an urban community teaching hospital.  The rates of proper culture and sensitivity testing, follow-up on culture results and proper antibiotics given all showed statistically significant improvement.