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Updated: Mar 28, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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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
PubMed
Abstract

Insights

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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