Fluoroquinolones target of cost-control efforts
Fluoroquinolones target of cost-control efforts
Antibiotic resistance also addressed
If you’re looking to your antibiotic list to save money this year, focus your eyes on fluoroquinolone use, pharmacists say. You may find prescriptions for the expensive antibiotics are on the increase at your hospital and resistance developing among in-house bugs.
Kathy Fudge, PharmD, manager of clinical pharmacy services at Riverside Methodist Hospital in Columbus, OH, says a shocking escalation in the use of IV ciprofloxacin a 40% rise between 1994 and 1995 prompted action that eventually led to tossing the drug from the hospital’s formulary, switching to ofloxacin, and in the process saving about $90,000.
"We went through a major formulary change," Fudge says, as the hospital signed up for Ortho McNeil’s fluoroquinolone switch program. Fudge says the drug company offered a first-year incentive to make the switch and that ofloxacin is priced about 20% lower than ciprofloxacin.
The formulary change led to pharmacists automatically substituting ciprofloxacin with ofloxacin. "The pharmacists could also go ahead and adjust dosages for urinary tract infections," Fudge says. That move alone halved the amount of ofloxacin used in UTIs.
But after a year, use of fluoroquinolones actually rose in the hospital, Fudge says, though total costs went down. And while cost control was a major consideration, resistance was another. Fudge says many of those earlier ciprofloxacin prescriptions were used to treat Pseudomonas infections that didn’t exist. That is, Pseudomonas isolates were found in fewer than 20% of cases tested back when the hospital had been contemplating a change in fluoroquinolone strategy.
A new, more aggressive program began, with pharmacists carefully monitoring ofloxacin orders, and getting many of them changed. "Now, the pharmacists are not soft-peddling it," Fudge says. "Our usage has definitely leveled off or decreased overall by a small amount." An added benefit: Lab data suggest that resistance rates have begun to drift down a bit, Fudge says.
One last step in the cut-fluoroquinolone-use campaign was to develop a physician reminder sheet that recaps for doctors the guidelines for proper fluoroquinolone use. This sheet is placed inside the patient’s medical record.
Vigorous IV to PO switch program needed
At the Des Moines (IA) General Hospital, Assistant Director of Pharmacy Chris Myers, BS, RPh, also noticed problems with fluoroquinolone use. "We noticed we were spending lots of money on fluoroquinolones and we were not actively out there trying to get orders converted from IV to PO."
With usage of the drugs steadily increasing, the pharmacy made a decision. "We looked at patients getting IV quinolones and decided that they could take the drug PO if they were on a PO diet," Myers says. Other criteria for IV to PO switching of fluoroquinolones include a dropping white blood cell count and temperature 24 to 48 hours post-admission, and the patient taking other medications by mouth.
Normally, pharmacists remind physicians that a particular patient has reached these criteria via a note on the patient’s chart, or by having a nurse relay the message. Nurses also play an important role in preventing unnecessary fluoroquinolone use by getting details on patients who say they are allergic to penicillin. Myers says many of these patients were automatically placed on ciprofloxacin instead of a cheaper cephalosporin, for fear of a cross-reaction. "Now we’re talking to the nurse to find out how bad the allergy is and we’re also pulling charts on previous admissions."
Thus far, the fluoroquinolone switch program has saved about $25,000, Myers says.
An IV to PO switch for fluoroquinolones was also the answer for the Norwegian-American Hospital in Chicago. "Fluoroquinolones are frequently prescribed and on the expensive side, says Richard Hrabski, PharmD. Pharmacists now place a note on qualifying patients’ charts 24 hours after admission to remind physicians a switch to PO is possible.
Cost isn’t the only reason some hospitals have decided to target fluoroquinolone use. Resistance is another. "We’re trying to decrease the amount of fluoroquinolone used because we feel resistance is directly related to the number of fluoroquinolone doses, says Carol Neely, PharmD, clinical coordinator of the Northern Mississippi Medical Center in Jackson.
That task will likely get more complicated this year. The Food and Drug Administration just approved the first of two new fluoroquinolones, levafloxacin. It will be joined later this year by sparfloxacin.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.