title: Parenteral to oral conversion of fluoroquinolones: low-hanging fruit for antimicrobial stewardship programs?
abstract: OBJECTIVE
  To estimate avoidable intravenous (IV) fluoroquinolone use in Veterans Affairs (VA) hospitals.
  
  
  METHODS
  A retrospective analysis of bar code medication administration (BCMA) data.
  
  
  METHODS
  Acute care wards of 128 VA hospitals throughout the United States.
  
  
  METHODS
  Data were analyzed for all medications administered on acute care wards between January 1, 2006, and December 31, 2010. Patient-days receiving therapy were expressed as fluoroquinolone-days (FD) and divided into intravenous (IV; all doses administered intravenously) and oral (PO; at least one dose administered per os) FD. We assumed IV fluoroquinolone use to be potentially avoidable on a given IV FD when there was at least 1 other medication administered via the enteral route.
  
  
  RESULTS
  Over the entire study period, 884,740 IV and 830,572 PO FD were administered. Overall, avoidable IV fluoroquinolone use accounted for 46.8% of all FD and 90.9% of IV FD. Excluding the first 2 days of all IV fluoroquinolone courses and limiting the analysis to the non-ICU setting yielded more conservative estimates of avoidable IV use: 20.9% of all FD and 45.9% of IV FD. Avoidable IV use was more common for levofloxacin and more frequent in the ICU setting. There was a moderate correlation between avoidable IV FD and total systemic antibiotic use (r = 0.32).
  
  
  CONCLUSIONS
  Unnecessary IV fluoroquinolone use seems to be common in the VA system, but important variations exist between facilities. Antibiotic stewardship programs could focus on this patient safety issue as a "low-hanging fruit" to increase awareness of appropriate antibiotic use.
authors.affiliation: IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, Utah 84148, USA. makoto.jones@va.gov
authors.forename: Makoto
authors.initials: M
authors.lastname: Jones
authors.forename: Benedikt
authors.initials: B
authors.lastname: Huttner
authors.forename: Karl
authors.initials: K
authors.lastname: Madaras-Kelly
authors.forename: Kevin
authors.initials: K
authors.lastname: Nechodom
authors.forename: Christopher
authors.initials: C
authors.lastname: Nielson
authors.forename: Matthew
authors.initials: M
authors.lastname: Bidwell Goetz
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Neuhauser
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rubin
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D003363:Cost Control; D016527:Drug Costs; D017723:Drug Utilization Review / Q000379:methods; D024841:Fluoroquinolones / Q000008:administration & dosage* / Q000191:economics; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D007263:Infusions, Parenteral; D007362:Intensive Care Units / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones