title: Drug costs and bacterial susceptibility after implementing a single-fluoroquinolone use policy at a university hospital.
abstract: The University of Kentucky Hospital investigated the feasibility of choosing a sole fluoroquinolone for its formulary in an effort to reduce costs without affecting clinical outcomes. A three-step process was used to plan, implement, and monitor the selection program. Based on the range of clinical indications, safety profile, local susceptibility, cost, and dosing convenience, levofloxacin was chosen over ciprofloxacin and gatifloxacin as the sole fluoroquinolone. Since the implementation of the program in May 2001, susceptibility to levofloxacin has been maintained or increased for the most common pathogens. In addition, University Hospital has saved nearly 100,000 dollars in antibiotic acquisition costs during the first 12 months after the switch. This assessment did not take into account effects in clinical outcomes, such as clinical failures (such as readmission rates), mortality, and adverse events, or measure changes in overall medical expenditures beyond drug acquisition costs. In the future, monitoring of overall patient care and medical care costs, in addition to susceptibility patterns and drug costs, will allow for a better understanding of the long-term benefits of this switch.
authors.affiliation: College of Pharmacy, University of Kentucky Medical Center, Lexington, KY, USA. rprapp01@uky.edu
authors.forename: Robert P
authors.initials: RP
authors.lastname: Rapp
authors.forename: Martin E
authors.initials: ME
authors.lastname: Evans
authors.forename: Craig
authors.initials: C
authors.lastname: Martin
authors.forename: Igho
authors.initials: I
authors.lastname: Ofotokum
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Empey
authors.forename: John A
authors.initials: JA
authors.lastname: Armitstead
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000191:economics* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects; D002939:Ciprofloxacin / Q000009:adverse effects / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use; D017046:Cost Savings; D016527:Drug Costs; D024841:Fluoroquinolones / Q000009:adverse effects / Q000191:economics* / Q000493:pharmacokinetics / Q000627:therapeutic use; D005572:Formularies, Hospital as Topic; D017721:Hospital Costs; D006785:Hospitals, University; D006801:Humans; D064704:Levofloxacin; D008826:Microbial Sensitivity Tests; D015242:Ofloxacin / Q000009:adverse effects / Q000191:economics* / Q000493:pharmacokinetics / Q000627:therapeutic use; D016134:Organizational Policy
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D064704:Levofloxacin; D015242:Ofloxacin