Reducing fluoroquinolone use in the adult emergency department of a community hospital

Purpose: The widespread use of fluoroquinolone antibiotics has contributed to the emergence of bacterial resistance among gram negative bacilli. Moreover, fluoroquinolones have been associated with an increased incidence and resistance of C. difficile infections. At Baptist Hospital of Miami, the resistance of inpatient E. coli isolates is currently greater than forty percent. The purpose of this study was to reduce fluoroquinolone use in the adult emergency department (ED).

Methods: This prospective, IRB-approved study included patients at least 18 years of age ordered levofloxacin 250 and 500 mg orally or intravenously in the adult ED. Data collection included patient demographics, diagnosis, laboratory values, and imaging studies. The primary outcome was to compare the number of levofloxacin doses dispensed during May to July 2011 (prior to the study period) with November 2011 to January 2012 (during the study period). Secondary outcomes included the number and type of pharmacist interventions and the prescribing trends for levofloxacin in the ED. Education to all ED staff, including physicians, nurses, and pharmacists, was carried out prior to initiation of this study.

Results: The number of levofloxacin doses dispensed decreased from 871 to 248 over the study period. A total of 66 patients ordered levofloxacin were evaluated. There were 37 clinical interventions made, which primarily resulted in a change in drug or dosage. Analysis of indications for prescribing levofloxacin demonstrated a reduction in prescribing for intra-abdominal infections, an increase for respiratory infections, and no difference for urinary tract infections.

Conclusion: Pharmacist intervention in the adult ED led to a significant reduction in levofloxacin use and optimization of antimicrobial therapy.