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Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital

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Abstract

Objective This study measured the impact of three interventions for physicians, in order to implement guidelines for sequential therapy (intravenous to oral conversion) with fluoroquinolones. Setting A Belgian university hospital with 1,065 beds. Method The first intervention consisted of the hospital-wide publication of guidelines in the local drug letter towards all prescribers. The consumption of fluoroquinolones was measured by means of an interrupted time-series (ITS) analysis 21 months before (period A) and 24 months after publication (period B). The second intervention was an educational interactive session, by infectious disease specialists, to the medical staff of orthopaedics and endocrinology. The third intervention comprised a proactive conversion programme on the abdominal surgery, gastro-enterology and plastic surgery wards, where pharmacists attached a pre-printed note with a suggestion to switch to an oral treatment every time a patient met the criteria for switching. The second and third intervention took place 6 months after the first intervention. Fluoroquinolone treatments were evaluated during a 2 month period before (group 1) and after the introduction of the second (group 2) and third (group 3) intervention. Main outcome measure The monthly ratio of intravenous versus total fluoroquinolone consumption (daily defined doses per 1,000 bed days) was measured to assess the impact of the first intervention. The impact of the second and third intervention was measured in relation to the number of days that intravenous therapy continued beyond the day that the patient fulfilled the criteria for sequential therapy and the antibiotic cost. Results The ITS demonstrated a reduction of 3.3% in the ratio of intravenous versus total consumption after the publication of the guidelines (P = 0.011). In group 1, patients were treated intravenously for 4.1 days longer than necessary. This parameter decreased in group 2 to 3.5 days and in group 3 to 1.0 day (P = 0.006). The mean additional cost for longer intravenous treatment decreased from 188.0€ in group 1, to 103.0€ in group 2 and 44.0€ in group 3 (P = 0.037). Conclusion This study demonstrated that active implementation of guidelines is necessary. A proactive conversion programme by a pharmacist resulted in a reduction in the duration of the intravenous treatment, and the treatment cost.

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References

  1. Fishman N. Antimicrobial stewardship. Am J Med. 2006;119:S53–61.

    Article  PubMed  Google Scholar 

  2. Nathawani D, Tillotson G, Davey P. Sequential antimicrobial therapy the role of quinolones. J Antimicrob Chemother. 1997;39:441–6.

    Article  Google Scholar 

  3. Dellit TH, Owens RC, McGowan JE, 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;44:159–77.

    Article  PubMed  Google Scholar 

  4. Sevinç F, Prins J, Koopmans R, Langendijk P, Bossuyt P, Dankert J, et al. Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital. J Antimicrob Chemother. 1999;43:601–6.

    Article  PubMed  Google Scholar 

  5. Kuti J, Le T, Nightindale C, Nicolau D, Quintiliani R. Pharmacoeconomics of a pharmacist-managed program for automatically converting levofloxacin route from IV to oral. Am J Health Syst Pharm. 2002;59:2209–15.

    PubMed  Google Scholar 

  6. Jensen K, Paladino J. Cost-effectiveness of abbreviating the duration of intravenous antibacterial therapy with oral fluoroquinolones. Pharmacoeconomics. 1997;11:64–74.

    Article  CAS  PubMed  Google Scholar 

  7. Vogel F. Intravenous/oral sequential therapy in patients hospitalised with community-acquired pneumonia. Drugs. 2002;62:309–17.

    Article  CAS  PubMed  Google Scholar 

  8. Conort O, Gabardi S, Didier M, Hazebroucq G, Cariou A. Intravenous to oral conversion of fluoroquinolones; knowledge versus clinical practice patterns. Pharm World Sci. 2002;24:67–70.

    Article  PubMed  Google Scholar 

  9. Beringer A, Nguyen K, Razeghi J. Implementing a program for switching from I.V. to oral antimicrobial therapy. Am J Health Syst Pharm. 2001;58:1146–9.

    Google Scholar 

  10. Ramirez J, Bordon J. Early switch from intravenous to oral antibiotics in hospitalized patients with bacteremic community-acquired Streptococcus pneumoniae pneumonia. Arch Intern Med. 2001;161:848–50.

    Article  CAS  PubMed  Google Scholar 

  11. Martinez M, Freire A, Castro I, Inaraja M, Ortega A, Del Campo V, et al. Clinical and economic impact of a pharmacist-intervention to promote sequential intravenous to oral clindamycin conversion. Pharm World Sci. 2000;22:53–8.

    Article  CAS  PubMed  Google Scholar 

  12. Laing R, Mackenzie A, Shaw H, Gould I, Douglas J. The effect of intravenous-to-oral switch guidelines on the use of parenteral antimicrobials in medical wards. J Antimicrob Chemother. 1998;42:107–11.

    Article  CAS  PubMed  Google Scholar 

  13. Zamin M, Pitre M, Conly J. Development of an intravenous-to-oral route conversion program for antimicrobial therapy at a Canadian tertiary care health facility. Ann Pharmacother. 1997;31:564–70.

    CAS  PubMed  Google Scholar 

  14. Von Gunten V, Amos V, Sidler A, Beney J, Troillet N, Reymond J. Hospital pharmacists’ reinforcement of guidelines for switching from parenteral to oral antibiotics: a pilot study. Pharm World Sci. 2003;25(2):52–5.

    Article  Google Scholar 

  15. Wetzstein G. Intravenous to oral (iv:po) anti-infective conversion therapy. Cancer Control. 2000;7:170–6.

    CAS  PubMed  Google Scholar 

  16. Van Bambeke F, Michot J, Van Eldere J, Tulkens P. Quinolones in 2005: an update. Clin Microbiol Infect. 2005;11:256–80.

    Article  PubMed  Google Scholar 

  17. Royal Decree of February 12, 2008 laying down the standards which a hospital pharmacy must meet in order to be approved. Brussels: Belgian Gazette; 12 Feb 2008. http://www.ejustice.just.fgov.be/doc/rech_n.htm. Accessed 14 Mar 2008.

  18. Ansari F, Gray K, Nathwani D, Phillips G, Ogston S, Ramsay C, et al. Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. JAC. 2003;52:842–8.

    CAS  PubMed  Google Scholar 

  19. Matowe L, Leister C, Crivera C, Korth-Bradley J. Interrupted time series analysis in clinical research. Ann Pharmacother. 2003;37:1110–6.

    Article  PubMed  Google Scholar 

  20. The WHO Collaborating Centre for Drug Statistics Methodology. ATC index with DDD’s. Oslo, Norway; 2003. http://www.whocc.no/atcddd/. Accessed 3 Apr 2006.

  21. Kuster S, Ruef C, Bollinger A, Ledergerber B, Hintermann A, Deplazes C, et al. Correlation between case mix index and antibiotic use in hospitals. JAC. 2008;62:837–42.

    CAS  PubMed  Google Scholar 

  22. R Development Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2007. ISBN 3-900051-07-0. http://www.R-project.org. Accessed 2 Jan 2007.

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Acknowledgements

The authors acknowledge prof. dr. E. Baert for making available the case-mix index, pharmacist N. Beck for the support in collecting the patient data and Mrs T. James for editing the text.

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Correspondence to Franky Buyle.

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Buyle, F., Vogelaers, D., Peleman, R. et al. Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital. Pharm World Sci 32, 404–410 (2010). https://doi.org/10.1007/s11096-010-9384-y

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