Effect of Utilization Policies for Fluoroquinolones: RESULTS

drug utilization

Over the 6-year study period, a total of 31 hospitals administered fluoroquinolones, and there were 169 hospital-year observations. Because hospitals with fewer than 10 acute care beds were excluded, data from only 27 hospitals (with 149 hospital-year observations) were examined in the final analysis.

Total Fluoroquinolone Use

Mean total fluoroquinolone use per district increased by more than 3 times over the 6 years, from 47.2 DDDs/1000 bed-days per year in 1997/1998 to 163.8 DDDs/1000 bed- days per year in 2002/2003 p < 0.001) (Table 1). Oral admin­istration as a percentage of total fluoroquinolone use descreased over the study period, from 89% in 1997/1998 to 78% in 2002/2003. The mean extent of use varied among the DHAs, from 78.9 DDDs/1000 bed-days per year in DHA A to 138.7 DDDs/1000 bed-days per year in DHA E. The utiliza­tion of fluoroquinolones did not differ statistically between small and medium-sized hospitals (p = 0.31) or between small and large facilities (p = 0.94); medium-sized and large hospitals were not compared directly. canadian pharmacy viagra

Table 1. Use of Fluoroquinolones in 31 Hospitals in Nova Scotia, 1997/1998 to 2002/2003


Fiscal Year; Drug Use (MeanDDDs/1000 bed-days per year and 95% CI)


Drug



1997/1998


1998/1999



1999/2000



2000/2001


2001/2002



2002/2003



Ciprofloxacin


30.8



29.4


38.4



46.8


51.0



52.5


(19.8-41.8)


(20.5-38.5)


(26.3-50.4)


(32.0-61.6)*


(39.1-63.0)*


(40.1-64.9)*



Levofloxacin


0.2


14.1


61.7



79.9


104.4


94.1


(0.0-0.5)


(4.7-23.5)



(39.9-83.6)*


(56.3-103.5)*


(71.8-137.1)*


(62.7-125.5)*



Gatifloxacin



0



0



0



0



0.7


11.5


(0.0-1.5)


(2.9-20.1)*



Moxifloxacin



0



0



0


0.4



2.0



2.8


(0.0-1.1)


(0.0-4.8)


(0.0-6.6)



Norfloxacin


14.4


12.0



6.2


1.9



2.4


1.9


(8.3-20.6)


(6.4-17.6)


(3.8-8.5)*


(0.0-4.0)*


(0.0-5.5)*



(0.0-4.3)



Ofloxacin


1.8



0.9


1.3



0.5


1.6



0.9


(0.0-4.0)


(0.1-1.6)


(0.0-2.9)


(0.0-1.3)


(0.1-3.2)


(0.0-2.3)



Total


47.2



56.5


107.6


129.6


162.2


163.8


(33.1-61.4)



(38.7-74.2)


(76.4-138.8)*


(97.7-161.4)*


(123.5-200.8)*


(124.3-203.3)*



CI
= confidence interval, DDD =



defined daily dose.

*Statistically significantdifference from 1997/1998 value (p < 0.05).

CiprofloxacinTotal annual ciprofloxacin use was highest over the period 2000/2001 to 2002/2003, relative to 1997/1998 and 1998/1999. The use of this drug in the final year of the study was 70.5% greater than use in the first year (52.5 DDDs/1000 bed-days in 2002/2003 versus 30.8 DDDs/1000 bed-days in 1997/1998) (Table 1). Oral use of this drug increased by 40.3% over the study peroid, whereas IV use increased by 290% (data not shown). The percentage of total use that involved oral administration declined from 90.5% in 1997/1998 to 76.0% in 2002/2003. The ratio of IV to oral use in 2002/2003 was 0.325.
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Table 2. Policies Related to Fluoroquinolone Use in 9 District Health Authorities in Nova Scotia


Policy Restricting Use


Pathway


District


For


For Respiratory


Policy for IV/PO


Ciprofloxacin


Fluoroquinolones*


Audits


Step-down


CAP


AECOPD

A

IV: yes;
pharmacist

follow-up

PO: no

No


Every 2
years, but only for
ciprofloxacin IV

Yes: chart
reminder

Yes

No

B

IV:
nonformularyt

No


Performed in
1999,

No

No

No

for
levofloxacin

C

IV: consult
only

Allowed for


3 times in
year

Yes:
pharmacist

Yes

Yes

PO: no

treatment
of CAP only

preceding
survey year (2003)

mandated,
automatic switch

D

No

No

No

Not for
fluoroquinolones

No

No

E


Not

No

“Limited
audits”

Yes, but
for levofloxacin and gatifloxacin only: pharmacist mandated, automatic
switch

No

No

F

IV and PO:
restricted drug request form

Allowed for
treatment of CAP only

Performed
in May 2000, for fluoroquinolones on formulary

No

No

No

G

No

No

No

Yes: chart
reminder

Yes

No

H

No;
guidelines in place but not enforced

No

Annual

Yes:
pharmacist recommendation

Yes

No

I

No

No

No

Yes, but
for ciprofloxacin only

Yes

No

AECOPD


= acute
exacerbation of chronic obstructive pulmonary disease, CAP

=


community-acquired pneumonia,


IV =
intravenous administration,
PO


= oral
administration.

*Defined as
levofloxacin, gatifloxacin, and moxifloxacin.

tWill
obtain upon request.

tNo
restrictions because of a lack of staff to provide monitoring.

Ciprofloxacin use varied greatly among the districts (Figure 1), with district I in particular having higher use; how­ever, this variation was not statistically significant. District I did not employ any restrictions on the use of ciprofloxacin (Table 2). The percentage of total use of this drug that involved oral administration also differed greatly among districts, ranging
from 58.7% to 95.1%.
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Figure 1. Use of respiratory

Figure 1. Use of respiratory fluoroquinolones and ciprofloxacin in 9 district health authorities in Nova Scotia (identifed by letters). The differences in usage among the districts was not statistically significant. DDD = defined daily dose.

Category: Drugs

Tags: antimicrobials, drug utilization, fluoroquinolones, policies

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