Effect of Antibiotic Stewardship on Fluoroquinolone Prescribing in Hospital

Research published in Clinical Infectious Diseases found that hospital-based stewardship interventions aimed at fluoroquinolone prescribing were associated with fewer prescriptions during hospitalization, but not at discharge.

In this retrospective cohort study, 11,748 general care patients hospitalized with pneumonia (n=6820) or positive urine culture (n=4928) from 48 hospitals were included. Each of the 48 hospitals responded to a survey on fluoroquinolone antibiotic stewardship.

Results of the survey found that 29.2% reported using pre-prescription approval and/or prospective audit and feedback to target fluoroquinolone prescribing. Fluoroquinolone stewardship, after adjustment, was associated with fewer patients receiving the drug (37.1% vs 48.2%; P = .01) and fewer fluoroquinolone treatment days per 1000 patients (2282 vs 3096 days/1000 patients; P = .01), which was driven by lower inpatient prescribing. The results also showed that 66.6% of treatment days occurred after discharge, and that twice as many new fluoroquinolone starts after discharge came from hospitals with stewardship in place (15.6% vs 8.4%; P =.003).

This study was observational, and therefore susceptible to confounding, and although study investigators adjusted for as many factors as possible, certain factors such as antibiotic resistance could not be adjusted for. They also were unable to assess the appropriateness of fluoroquinolone prescribing or compensatory increases in other potentially inappropriate antibiotic classes. Researchers also chose to only evaluate 2 of the most effective and common interventions, and did not evaluate the strength of strategy implementation. Several other limitations were noted, including this being a single-state study, the reliance on self-reporting of hospital practices, and an inability to assess patient compliance with prescriptions.

The results revealed that hospital-based stewardship was effective, but a failure to address antibiotic prescription at discharge may limit their effect. The study investigators suggested that, “[g]iven the frequency of fluoroquinolone prescribing after discharge, hospital-based stewardship programs should implement discharge stewardship, or interventions to address discharge antibiotic prescribing.” They further suggest that such strategies will need to combat the advantages of fluoroquinolone use and focus on the disadvantages, while also offering alternatives.

Reference

Vaughn VM, Gandhi T, Conlon A, Chopra V, Malani AN, Flanders SA. The association of antibiotic stewardship with fluoroquinolone prescribing in Michigan hospitals: A multi-hospital cohort study [published online February 13, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciy1102