Ciprofloxacin use under a reserved drug and stepdown promotion program

Area of Science:

• Pharmacoeconomics
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Parenteral ciprofloxacin (PC) use was evaluated following introduction of a reserved antimicrobial drug program.
• A significant portion of PC courses were initiated in hematology and intensive care units.
• Common indications included febrile neutropenia, respiratory tract infections, and gram-negative sepsis.

Purpose of the Study:

• To assess the appropriateness of parenteral ciprofloxacin (PC) use.
• To evaluate the effectiveness of an intravenous-oral stepdown program.
• To determine the economic impact of PC utilization and stepdown therapy.

Main Methods:

• Retrospective review of 50 randomly selected PC treatment courses from 92 initiated courses.
• Analysis of treatment indications, route of administration appropriateness, and stepdown therapy.
• Cost analysis including acquisition and delivery, comparing IV vs. oral stepdown therapy.

Main Results:

• Initial IV PC use was appropriate in 92% of courses.
• Stepdown therapy occurred in 34% of courses; 35% of eligible patients did not receive oral therapy.
• Unnecessary IV route use occurred in 20% of PC treatment days, with higher costs in hematology.
• Implementing stepdown therapy reduced mean daily costs and avoided significant drug costs.

Conclusions:

• While initial IV PC use was often appropriate, opportunities exist to optimize stepdown therapy.
• Improved adherence to stepdown criteria could yield substantial cost savings.
• Antimicrobial stewardship programs incorporating IV-to-oral switch protocols are crucial for efficient ciprofloxacin use.