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Related Experiment Video

Updated: Dec 18, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Decreased Outpatient Fluoroquinolone Prescribing Using a Multimodal Antimicrobial Stewardship Initiative.

Kevin Lin1, Yorgo Zahlanie2, Jessica K Ortwine1,3

  • 1Department of Pharmacy, Parkland Health & Hospital System, Dallas, Texas, USA.

Open Forum Infectious Diseases
|June 18, 2020
PubMed
Summary

A stewardship initiative significantly reduced fluoroquinolone prescriptions by 39% and inappropriate use from 53% to 34%. This highlights the effectiveness of antimicrobial stewardship in optimizing antibiotic prescribing for better patient outcomes.

Keywords:
antimicrobial stewardshipfluoroquinoloneoutpatient stewardship

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Area of Science:

  • Infectious Diseases
  • Antimicrobial Stewardship
  • Public Health

Background:

  • Fluoroquinolones are widely prescribed outpatient antibiotics with significant associated risks.
  • This study addresses the need to evaluate interventions aimed at reducing fluoroquinolone overuse in ambulatory care settings.

Purpose of the Study:

  • To assess the impact of a multimodal antimicrobial stewardship initiative on fluoroquinolone prescribing patterns.
  • To quantify changes in both total and inappropriate fluoroquinolone use in outpatient settings.

Main Methods:

  • A multimodal stewardship program was implemented, including provider education, formulary restrictions, and order set modifications.
  • Retrospective chart review of fluoroquinolone prescriptions in primary care, emergency, and urgent care settings before and after initiative implementation.
  • Inappropriate use was defined by specific indications (cystitis, bronchitis, sinusitis) without complicating factors.

Main Results:

  • Total fluoroquinolone prescriptions decreased by 39% (P < .01) per 1000 patient visits.
  • Inappropriate fluoroquinolone use significantly reduced from 53% to 34% (P < .01).
  • The majority of inappropriate prescriptions were for cystitis, with smaller proportions for bronchitis and sinusitis.

Conclusions:

  • A comprehensive antimicrobial stewardship initiative effectively reduced overall and inappropriate outpatient fluoroquinolone prescribing.
  • The findings support the implementation of similar stewardship programs to optimize antibiotic use and mitigate risks.