title: An interventional program to improve antibiotic use.
abstract: BACKGROUND
  Large volume and often inappropriate use of specific antimicrobial agents increase selective pressure for emergence of resistant bacteria and place strain on the pharmacy budget.
  
  
  OBJECTIVE
  To initiate a multidisciplinary program designed to align intravenous vancomycin and fluoroquinolone prescribing practices with guidelines for appropriate use of these agents.
  
  
  METHODS
  A multidisciplinary, prospective interventional program was implemented to encourage early discontinuation of inappropriate vancomycin and fluoroquinolone therapy and decrease inappropriate duplicative gram-negative coverage using fluoroquinolones. A computerized review was performed for patients receiving intravenous vancomycin and fluoroquinolones for 1998 in a Veterans Affairs Medical Center. In June 1999, guidelines were disseminated and an interventional program was initiated, with a monthly conference for medical residents regarding antimicrobial resistance and local hospital practices. Concurrently, a prospective review of new orders was assessed by the clinical pharmacist and interventions performed when inappropriate use occurred.
  
  
  RESULTS
  The interventional program was successful in reducing unnecessary duplicative gram-negative coverage with intravenous fluoroquinolones by 26% (p < 0.001) from 1998 to 2001. Overall, a 43% reduction in the number of courses of intravenous fluoroquinolones was seen during these 4 years. Courses lasting >5 days were reduced by 22% (p < 0.001). Vancomycin prescriptions deemed inappropriate that were administered >5 days were reduced by 16% (p < 0.001) during the same time period. The interventions performed by the clinical pharmacist were deemed successful, with a 76% acceptance rate by providers.
  
  
  CONCLUSIONS
  Education of physicians through monthly conferences and personal interventions resulted in an increase in appropriate empiric antibiotic use, a decrease in the duration of inappropriate use, and a decrease in duplicate gram-negative coverage.
authors.affiliation: Pharmacy Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Feucht
authors.forename: Louis B
authors.initials: LB
authors.lastname: Rice
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016527:Drug Costs / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D004502:Education, Medical, Continuing / Q000379:methods*; D024841:Fluoroquinolones; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D010820:Physicians / Q000592:standards; D017410:Practice Guidelines as Topic; D011552:Pseudomonas Infections / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D014640:Vancomycin