Total annual use of all fluoroquinolones increased significantly over the study period. This corroborates other antimicrobial utilization studies, which showed an overall decrease in consumption of antimicrobials but an increase in fluoroquinolone use in Canada from 1995 to 1998. The total fluoroquinolone use reported here (mean of 163.8 DDDs/1000 bed-days for 2002/2003) was similar to that reported for 42 hospitals in the United States (mean of 150 DDDs/1000 bed-days for 2003). There is evidence to suggest that increased bacterial resistance is correlated with increased use of antimicrobials. According to the Canadian Bacterial Surveillance Network, resistance to fluoroquinolones is increasing in Canada. Between 1993 and 1998, resistance of Streptococcus pneumoniae to fluoroquinolones increased from 1.5% to 2.9%, which coincided with an increase in the number of prescriptions for ciprofloxacin during the same period. Rates of resistance to fluoroquinolones are still low; however, as the use of these agents increases, resistance is expected to increase as well.
Norfloxacin was the one fluoroquinolone for which utilization decreased over the study period. Use of this drug was higher in small and medium-sized hospitals than in large hospitals. This may be because norfloxacin was removed from the formulary of one of the large hospitals in the province in November 1996 (just before the beginning of the study period). The reason for removal was primarily to “streamline” the use of antibiotics in the institution. Streamlining is a process that many hospitals use to simplify therapeutic choices and to contain costs. buy generic viagra
The lack of statistically significant differences in fluoro- quinolone use related to the presence or absence of at least one utilization policy may have been due to the small number of observations and the relatively short period of the study. As well, the presence of a drug utilization policy does not necessarily mean that it is enforced. One of the biggest problems with utilization policies that rely on completion of forms by the physician is the resources required for pharmacy auditing and follow-up. One survey respondent commented that the DHA had never implemented antimicrobial utilization policies because there were insufficient staff to monitor adherence. Insufficient staffing, especially in rural areas, is an issue facing many hospital pharmacies in Nova Scotia, one that can impede optimization of use of antimicrobials through utilization policies. In a previous study, a US hospital pharmacy implemented an interventional program to improve antibiotic use. The program consisted of a pharmacist’s personal intervention and an educational component, and it decreased ciprofloxacin use by 43%. Another study examined an intervention that involved completion of restriction forms, which were audited daily, with prescribers receiving feedback from infectious disease specialists twice a week. Over a 4-year period with the program in place (from 1992 to 1995), expenditures for ciprofloxacin decreased, but in 1996, costs increased sharply (by 69%) when the capacity to audit the forms and provide feedback was withdrawn. Ongoing education and follow-up are necessary to successfully operate restriction policies. levitra plus