Infections with antimicrobial-resistant bacteria result in increased patient morbidity and mortality, and extra costs to the health care system. There is mounting evidence to suggest an association between antimicrobial use in hospitals and antimicrobial resistance. Fluoroquinolones are useful in the treatment of a variety of infections. Unfortunately, these drugs are sometimes used inappropriately, and these uses may contribute to increasing bacterial resistance and drug expendi- tures. Many hospitals have implemented policies and programs to limit and monitor inappropriate use. The effect of such policies on fluoroquinolone use across the province of Nova Scotia, Canada, is unknown.
In Nova Scotia, district health authorities (DHAs) are responsible for providing care in acute care facilities and for monitoring and evaluating the use of medications prescribed, including antimicrobial agents. However, monitoring systems may not be well established, and even when they are present, data collection and analysis methods may differ across the province. Furthermore, no system exists to routinely and systematically collect and compare data at the district or provincial level.
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Since the 1970s, European and Nordic countries have employed the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) classification system with defined daily doses (DDDs) as a standardized method to compare antimicrobial utilization within and between countries. The ATC/DDD system is managed by the WHO Collaborating Centre for Drug Statistics Methodology, with expert advice from the corresponding WHO International Working Group. The working group comprises members from different professional backgrounds, who represent the 6 WHO global regions. The DDD is the assumed average maintenance dose for the main indication of a particular drug. The actual dose for individual patients may differ according to individual characteristics. Drug consumption data presented as DDDs provide a rough estimate of consumption and yield a fixed unit of measure, independent of price and formulation, which allows researchers to assess and compare trends among population groups and countries.
The objectives of this study were to evaluate the use of fluoroquinolones in Nova Scotia hospitals using the ATC/DDD classification system and to examine the influence of utilization policies on the use of all fluoroquinolones (i.e., throughout the hospital) and of respiratory fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin), especially in relation to community-acquired pneumonia.
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