Approaches to drug therapy, formulary, and pathway management in a large community hospital

Use of a clinical pathway for the management of community-acquired pneumonia (CAP) at a large community hospital is described. The pathway was developed and implemented by a multidisciplinary team. Fluoroquinolone therapeutic interchange and intravenous (i.v.) to oral (p.o.) conversion were part of the pathway; through literature review, levofloxacin was chosen as the preferred quinolone. Outcomes (length of stay [LOS] and readmission rates for pathway and nonpathway patients with CAP, economic impact of the fluoroquinolone interchange protocol, and resistance patterns) were evaluated. For pathway patients in 1998, LOS was 1.2 days shorter and the readmission rate was lower. Projected drug cost savings as a result of the fluoroquinolone interchange protocol were more than $22,000 annually. Pharmacists' interventions in antimicrobial prescribing for CAP patients can lead to cost efficiency and positively affect patient outcomes.