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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Antibiotic stewardship: When making a penny costs more than a penny

Antibiotic stewardship – while labeled as the last-ditch stand to stave off a post-antibiotic era – actuaully can begin on a fairly mundane level. Sort of like realizing it now costs more than a penny to make a penny, but that’s a discussion for another day that will probably never arrive in this blog.

In terms of long-hanging fruit in the antibiotic stewardship game, consider the results of a recent research identifying a systemic problem involving the unnecessary use of IV fluoroquinolones in the acute care wards of hospitals. While the data came from 128 Veterans Administration (VA) hospitals, the research suggests this is a trend that all health care systems should address through antimicrobial stewardship programs.1 “For antibiotic stewardship, we wanted to pick a topic where we could get a sense of how things were going in the VA and probably elsewhere, as well,” says Makoto Jones, MD, research investigator and staff physician at the VA Salt Lake City Health Care System in Salt Lake City, UT. Investigators found that avoidable IV fluoroquinolone use overall was 46.8% of all fluoroquinolone days. The percentage of IV fluoroquinolone days that was avoidable was 90.9%.1 Astounding, yes, but parenteral to oral conversion of fluoroquinolones is a relatively easy stewardship step to take, he notes. “It may be a marker of how well an antibiotic stewardship program is doing,” Jones adds. The 152-bed VA hospital system uses a barcode medication administration to make sure that the right patient gets the right medication. The VA electronic health record collects these and other data, including admission/discharge/transfer data, which tells where a patient is at any given time in the hospital. “We were able to look at whether an antibiotic was given intravenously or by mouth,” Jones says. “We set up the rules so if somebody was given IV antibiotics for two days in a row, we took that as their intention to give IV antibiotics.” Barcode medication administration data were used because medication orders often can change within the first day – sometimes even before a single dose is administered, he explains. Researchers focused on fluoroquinolones because the drug’s bioavailability is the same whether it’s given intravenously or orally. So if the patient’s gastrointestinal tract could handle the oral medication then many patients could be switched from IV to oral antibiotics, he adds. “It’s an easy switch, and we have randomized control trials saying it appears to get people out the door faster and in a safe manner,” Jones says. “If we continue to give patients IV antibiotics they probably stay in the hospital longer than they need to.”

Reference: 1. Jones M, Huttner B, Madaras-Kelly K, et al. Parenteral to oral conversion of fluoroquinolones: low-hanging fruit for antimicrobial stewardship programs? Infect Cont & Hosp Epid. 2012;33(4):362-367.

For more on this story see the May 2012 issue of Hospital Infection Control and Prevention.