Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T06:44:53.271Z Has data issue: false hasContentIssue false
  • English
  • Français

Parenteral to Oral Conversion of Fluoroquinolones: Low-Hanging Fruit for Antimicrobial Stewardship Programs?

Published online by Cambridge University Press:  02 January 2015

Makoto Jones ,
Benedikt Huttner ,
Karl Madaras-Kelly ,
Kevin Nechodom ,
Christopher Nielson ,
Matthew Bidwell Goetz ,
Melinda M. Neuhauser ,
Matthew H. Samore  and
Michael A. Rubin
Makoto Jones*
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Benedikt Huttner
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Karl Madaras-Kelly
Affiliation:
Boise VA Medical Center, Boise, and College of Pharmacy, Idaho State University, Meridian, Idaho
Kevin Nechodom
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Christopher Nielson
Affiliation:
VA Sierra Nevada Health Care System and University of Nevada School of Medicine, Reno, Nevada
Matthew Bidwell Goetz
Affiliation:
VA Greater LA Healthcare System and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
Melinda M. Neuhauser
Affiliation:
VA Pharmacy Benefits Management Services, Hines, Illinois
Matthew H. Samore
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Michael A. Rubin
Affiliation:
IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, Utah
*
VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148 (makoto.jones@va.gov)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To estimate avoidable intravenous (IV) fluoroquinolone use in Veterans Affairs (VA) hospitals.

Design.

A retrospective analysis of bar code medication administration (BCMA) data.

Setting.

Acute care wards of 128 VA hospitals throughout the United States.

Methods.

Data were analyzed for all medications administered on acute care wards between January 1, 2006, and December 31, 2010. Patient-days receiving therapy were expressed as fluoroquinolone-days (FD) and divided into intravenous (IV; all doses administered intravenously) and oral (PO; at least one dose administered per os) FD. We assumed IV fluoroquinolone use to be potentially avoidable on a given IV FD when there was at least 1 other medication administered via the enteral route.

Results.

Over the entire study period, 884,740 IV and 830,572 PO FD were administered. Overall, avoidable IV fluoroquinolone use accounted for 46.8% of all FD and 90.9% of IV FD. Excluding the first 2 days of all IV fluoroquinolone courses and limiting the analysis to the non-ICU setting yielded more conservative estimates of avoidable IV use: 20.9% of all FD and 45.9% of IV FD. Avoidable IV use was more common for levofloxacin and more frequent in the ICU setting. There was a moderate correlation between avoidable IV FD and total systemic antibiotic use (r = 0.32).

Conclusions.

Unnecessary IV fluoroquinolone use seems to be common in the VA system, but important variations exist between facilities. Antibiotic stewardship programs could focus on this patient safety issue as a “low-hanging fruit” to increase awareness of appropriate antibiotic use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 4: Special Topic Issue: Antimicrobial Stewardship , April 2012 , pp. 362 - 367
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Amodio-Groton, M, Madu, A, Madu, CN, et al. Sequential parenteral and oral ciprofloxacin regimen versus parenteral therapy for bacteremia: a pharmacoeconomic analysis. Ann Pharma-cother 1996;30:596–602.Google Scholar
2. Al-Eidan, FA, McElnay, JC, Scott, MG, Kearney, MP, Troughton, KE, Jenkins, J. Sequential antimicrobial therapy: treatment of severe lower respiratory tract infections in children. JAntimicrob Chemother 1999;44:709–715.Google Scholar
3. Siegel, RE, Halpern, NA, Almenoff, PL, Lee, A, Cashin, R, Greene, JG. A prospective randomized study of inpatient intravenous antibiotics for community-acquired pneumonia: the optimal duration of therapy. Chest 1996;110:965–971.Google Scholar
4. Chan, R, Hemeryck, L, O'Regan, M, Clancy, L, Feely, J. Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial. BMJ 1995;310:1360–1362.CrossRefGoogle Scholar
5. Oosterheert, JJ, Bonten, MJ, Schneider, MM, et al. Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial. JAMA 2006;333:1193.Google ScholarPubMed
6. Athanassa, Z, Makris, G, Dimopoulos, G, Falagas, ME. Early switch to oral treatment in patients with moderate to severe community-acquired pneumonia: a meta-analysis. Drugs 2008;68:2469–2481.Google Scholar
7. Omidvari, K, de Boisblanc, BP, Karam, G, Nelson, S, Haponik, E, Summer, W. Early transition to oral antibiotic therapy for community-acquired pneumonia: duration of therapy, clinical outcomes, and cost analysis. Respir Med 1998;92:1032–1039.CrossRefGoogle ScholarPubMed
8. Davis, SL, Delgado, G Jr., McKinnon, PS. Pharmacoeconomic considerations associated with the use of intravenous-to-oral moxifloxacin for community-acquired pneumonia. Clin Infect Dis 2005;41(Suppl 2):S136–S143.Google Scholar
9. Turnidge, J. Pharmacokinetics and pharmacodynamics of fluoroquinolones. Drugs 1999;58(Suppl 2):29–36.CrossRefGoogle ScholarPubMed
10. Debon, R, Breilh, D, Boselli, E, et al. Pharmacokinetic parameters of ciprofloxacin (500 mg/5 mL) oral suspension in critically ill patients with severe bacterial pneumonia: a comparison of two dosages. J Chemother 2002;14:175–180.Google Scholar
11. de Marie, S, VandenBergh, MF, Buijk, SL, et al. Bioavailability of ciprofloxacin after multiple enteral and intravenous doses in ICU patients with severe gram-negative intra-abdominal infections. Intensive Care Med 1998;24:343–346.Google Scholar
12. Solomkin, JS, Reinhart, HH, Dellinger, EP, et al. Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. The Intra-Abdominal Infection Study Group. Ann Surg 1996;223:303–315.Google Scholar
13. Cohn, SM, Sawyer, MD, Burns, GA, Tolomeo, C, Milner, KA. Enteric absorption of ciprofloxacin during tube feeding in the critically ill. J Antimicrob Chemother 1996;38:871–876.Google Scholar
14. Kanji, S, McKinnon, PS, Barletta, JF, Kruse, JA, Devlin, JW. Bioavailability of gatifloxacin by gastric tube administration with and without concomitant enteral feeding in critically ill patients. Crit Care Med 2003;31:1347–1352.Google Scholar
15. Halm, EA, Switzer, GE, Mittman, BS, Walsh, MB, Chang, CC, Fine, MJ. What factors influence physicians' decisions to switch from intravenous to oral antibiotics for community-acquired pneumonia? J Gen Intern Med 2001;16:599–605.Google Scholar
16. Conort, O, Gabardi, S, Didier, MP, Hazebroucq, G, Cariou, A. Intravenous to oral conversion of fluoroquinolones: knowledge versus clinical practice patterns. Pharm World Sci 2002;24:67–70.CrossRefGoogle ScholarPubMed
17. Przybylski, KG, Rybak, MJ, Martin, PR, et al. A pharmacist-initiated program of intravenous to oral antibiotic conversion. Pharmacotherapy 1997;17:271–276.Google Scholar
18. Dellit, TH, Owens, RC, McGowan, JE Jr., et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.Google Scholar
19. Hulgan, T, Rosenbloom, ST, Hargrove, F, et al. Oral quinolones in hospitalized patients: an evaluation of a computerized decision support intervention. J Intern Med 2004;256:349–357.CrossRefGoogle ScholarPubMed
20. Fischer, MA, Solomon, DH, Teich, JM, Avorn, J. Conversion from intravenous to oral medications: assessment of a computerized intervention for hospitalized patients. Arch Intern Med 2003; 163:2585–2589.CrossRefGoogle ScholarPubMed
21. Polk, RE, Fox, C, Mahoney, A, Letcavage, J, MacDougall, C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007;44:664–670.Google Scholar
22. QualityNet. The specifications manual for national hospital quality measures, version 2.3b. In: Collaborative work of the Centers for Medicare & Medicaid Services and The Joint Commission; Discharges 10/1/2007 to 03/31/2008.Google Scholar
23. Kouranos, VD, Karageorgopoulos, DE, Peppas, G, Falagas, ME. Comparison of adverse events between oral and intravenous formulations of antimicrobial agents: a systematic review of the evidence from randomized trials. Pharmacoepidemiol Drug Saf 2009;18:873–879.Google Scholar
24. Ho, BP, Lau, TT, Balen, RM, Naumann, TL, Jewesson, PJ. The impact of a pharmacist-managed dosage form conversion service on ciprofloxacin usage at a major Canadian teaching hospital: a pre- and post-intervention study. BMC Health Serv Res 2005;5:48.CrossRefGoogle Scholar
25. Werner, NL, Hecker, MT, Sethi, AK, Donskey, CJ. Unnecessary use of fluoroquinolone antibiotics in hospitalized patients. BMC Infect Dis 2011;11:187.Google Scholar
26. Chui, D, Cheng, L, Tejani, AM. Clinical equivalency of ciprofloxacin 750mg enterally and 400mg intravenously for patients receiving enteral feeding: systematic review. Can J Hosp Pharm 2009;62:127–134.Google Scholar
27. Mimoz, O, Binter, V, Jacolot, A, et al. Pharmacokinetics and absolute bioavailability of ciprofloxacin administered through a nasogastric tube with continuous enteral feeding to critically ill patients. Intensive Care Med 1998;24:1047–1051.CrossRefGoogle ScholarPubMed
28. Sevinc, F, Prins, JM, Koopmans, RP, et al. Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital. J Antimicrob Chemother 1999;43:601–606.Google Scholar