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INFECTIOUS DISEASES

An Interventional Program to Improve Antibiotic Use

Clinical Infectious Disease Pharmacist, Pharmacy Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH

Louis B Rice, MD

Chief of Medicine, Medical Service, Louis Stokes Cleveland Veterans Affairs Medical Center; Vice Chairman of Medicine, Department of Medicine, University Hospital, Case Western Reserve University, Cleveland

Reprints: Louis B Rice MD, 10701 E. Boulevard (111W), Cleveland, OH 44106-1702, FAX 216/231-3289, E-mail louis.rice{at}med.va.gov

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.

Key Words: antibiotic resistance, antibiotic utilization, prescribing practice

Published Online, March 26, 2003. www.theannals.com, DOI 10.1345/aph.1C166

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