Optimizing use of ciprofloxacin: a prospective intervention study.
OBJECTIVE
Antimicrobial resistance to ciprofloxacin is increasing. The objective of this study was to reduce the number of inappropriate prescriptions and to improve the quality of ciprofloxacin prescriptions by means of educational intervention.


METHODS
In a teaching hospital five units of the Departments of Internal Medicine, Gastro-Enterology, Surgery, Urology and Pulmonary Diseases, selected because of a high rate of ciprofloxacin prescription, participated in a prospective intervention study. The quantity and the quality of prescriptions were reviewed before and after educational intervention and during follow-up. The quality of each ciprofloxacin prescription was independently evaluated by two medical microbiologists. During the intervention period, a medical microbiologist discussed the appropriateness of prescribing ciprofloxacin with prescribing clinicians, and educational presentations were given to clinicians of participating units. Regression analysis was used to analyse trends in time-series data.


RESULTS
The number of ciprofloxacin prescriptions decreased from 81 prescriptions/1000 admissions before intervention to 32 prescriptions/1000 admissions after intervention, a significant reduction of 60.5%. Appropriate prescriptions significantly increased. Significantly fewer inappropriate prescriptions were prescribed after intervention and/or during follow-up. At this time, 23 ciprofloxacin prescriptions/1000 admissions were prescribed, a total reduction of 71.3% compared with baseline.


CONCLUSIONS
In a hospital with relatively low baseline ciprofloxacin consumption, intervention by direct consultation of a medical microbiologist and educational presentations led to 3-4-fold sustained reduction in the use of ciprofloxacin and significant improvement in quality of ciprofloxacin prescriptions. Close collaboration between clinicians and medical microbiologists can provide a major contribution to the prudent hospital use of antimicrobial agents.
van Hees
Babette C
BC
Department of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands. b.van.hees@antonius.net
de Ruiter
Erica
E
Wiltink
Ed H
EH
de Jongh
Bartelt M
BM
Tersmette
Matthijs
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000600:supply & distribution* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000600:supply & distribution* / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000592:standards*; D024881:Drug Resistance, Bacterial; D005260:Female; D005759:Gastroenteritis / Q000188:drug therapy; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy; D018805:Sepsis / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin