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In a bind: a quality improvement project for reducing fluoroquinolones drug-drug interactions with multivalent
Emily A Siegrist1, Steven J Pan2, Maria Alkozah3
1Department of Pharmacy, OU Health, Oklahoma City, OK, USA.
Jac-Antimicrobial Resistance
|March 27, 2026
Summary
Implementing interventions reduced fluoroquinolone (FQ) and multivalent cation co-administration, a key factor in FQ resistance. Further stewardship is needed to minimize this drug-drug interaction.
Area of Science:
- Pharmacology
- Infectious Diseases
- Drug Interactions
Background:
- Fluoroquinolone (FQ) bioavailability is significantly reduced by co-administration with multivalent cations.
- This interaction is an independent risk factor for FQ resistance, a growing concern with increased oral antimicrobial use.
Purpose of the Study:
- To examine the incidence of FQ drug-drug interactions (DDIs) after implementing a bundle of interventions.
- To assess the effectiveness of interventions in reducing FQ and multivalent cation co-administration.
Main Methods:
- A quality improvement study was conducted.
- Interventions included nursing education, updated medication administration record (MAR) comments, and new administration times.
- Patient subgroup analysis focused on co-administration timing.
Main Results:
- Co-administration of FQ with multivalent cations within 2 hours decreased significantly post-intervention (22% vs. 62%, P < 0.001).
- The intervention bundle reduced but did not eliminate the FQ-cation interaction.
Conclusions:
- Interventions can decrease FQ-multivalent cation co-administration, a risk factor for FQ resistance.
- Antimicrobial stewardship programs should consider similar interventions, given the increasing use of oral antibiotics.
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