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Published on: August 30, 2018
Impact of a 5-year antimicrobial stewardship program focusing on fluoroquinolone prescriptions
Stéphane Pédeboscq1, Nahema Issa2, Marin Lahouati1
1Pharmacy Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France.
Objectives:
Within the context of the wide use of fluoroquinolones (FQs) and the emergence of multidrug-resistant bacteria, French recommendations concerning the appropriate use of systemic FQs in adults were published in 2015. This study assessed the impact of antibiotic stewardship intervention on the use of FQs over a 5-year period.
Methods:
Five annual audits were performed to evaluate FQ prescriptions. Following the baseline audit, a campaign of appropriate antibiotic use was initiated with courses on antibiotics including FQs. All audits included quantitative and qualitative evaluations to calculate an index of therapeutic adequacy (ITA) with six criteria: indication, molecule type, dosage, duration, route of administration and association. These audits were performed annually from 2015 to 2019.
Key Findings:
The number of prescriptions decreased substantially from 90 in 2015 to 17 in 2019. This reduction was consistent with consumption data, such that the defined daily dose for 1000 bed days diminished from 67 in 2015 to 42 in 2019. Between 2015 and 2016, the ITA decreased significantly from 3.27 to 1.79 (P = 0.001), corresponding to an improvement in prescription quality. The ITA stabilised between 2016 and 2019. Moreover, improvements were observed in the proportion of entirely conforming prescriptions, conformity of indications, choice of molecule type among FQs and proportion of prescriptions with non-conforming treatment durations.
Conclusions:
Between 2015 and 2019, we observed quantitative and qualitative improvements in FQ prescriptions within the hospital. Prescription follow-up through annual audits, combined with training courses, contributed to consistent results.
Insights
French antibiotic stewardship interventions significantly reduced fluoroquinolone (FQ) prescriptions and improved prescription quality over five years. Audits and training enhanced appropriate FQ use, decreasing prescriptions and increasing therapeutic adequacy.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Pharmacology
Background:
- Fluoroquinolones (FQs) are widely used, contributing to multidrug-resistant bacteria.
- French national guidelines for appropriate systemic FQ use in adults were established in 2015.
- Effective antibiotic stewardship is crucial for managing antimicrobial resistance.
Purpose of the Study:
- To assess the impact of an antibiotic stewardship intervention on fluoroquinolone (FQ) utilization in a hospital setting.
- To evaluate changes in both the quantity and quality of FQ prescriptions over a five-year period.
- To determine the effectiveness of annual audits and educational campaigns in promoting appropriate antibiotic use.
Main Methods:
- Conducted five annual audits from 2015 to 2019 to evaluate FQ prescriptions.
- Implemented an educational campaign on appropriate antibiotic use, including FQs, post-baseline audit.
- Calculated an Index of Therapeutic Adequacy (ITA) based on six criteria: indication, molecule type, dosage, duration, route, and association.
Main Results:
- FQ prescriptions decreased significantly from 90 in 2015 to 17 in 2019.
- Defined daily doses per 1000 bed days reduced from 67 to 42 between 2015 and 2019.
- The Index of Therapeutic Adequacy (ITA) improved significantly from 3.27 to 1.79 between 2015 and 2016, then stabilized, indicating enhanced prescription quality.
Conclusions:
- The study demonstrated significant quantitative and qualitative improvements in FQ prescribing practices.
- Continuous monitoring via annual audits and targeted training were effective in achieving sustained positive results.
- Antibiotic stewardship programs are vital for optimizing antimicrobial use and combating resistance.
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