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BACKGROUND: Fluoroquinolones are broad-spectrum anti-microbial agents with activity against both gram-positive and negative bacteria. Furthermore, they are able to achieve adequate serum concentrations to treat a variety of systemic infections via oral administration. Due to the broad spectrum of their anti-microbial activity, favorable pharmacokinetic characteristics and safety profiles, their clinical uses are increasing recently. However, extensive use of broad-spectrum antibiotics, such as fluoroquinolones, may lead to the emergence of resistant strain. Besides, the acquisition cost of fluoroquinolones is rather expensive. Therefore, we conducted a utilization evaluation with executive and educational interventions to determine if these agents were used appropriately.
METHOD: The study enrolls all patients prescribed fluoroquinolones at the National Cheng Kung University Hospital. The Department of Pharmacy and the Committee on Infection Control developed "the Use Criteria of Fluoroquinolones" by referring to the literature and the Guidelines from National Health Insurance. For the retrospective and prospective evaluations, data were collected at two periods, i.e. November 1995 to January 1996 and November 1996 to January 1997. We also sampled the data during April to August 1996 to investigate the effect from the implementation of "The injectable antibiotic prescription sheet". We selected 300 cases for evaluation in each stage using a randomized stratified sampling.
RESULTS: The percentage of patients prescribed FQ with inappropriate justification of use decreased significantly (p=0.001) after intervention, but that of patients with controversial appropriateness increased (p=0.01). Among the indications classified as controversial appropriateness, the percentage of "using fluoroquinolones for infections without initiating with the first or second line antibiotics" elevated markedly. In the group of "inappropriate use", the percentage of "indications for acute or chronic otitis media" decreased considerably, while that of "discrepancy with the result of the bacterial culture* increased significantly. On the other hand, the appropriateness of doses, interval, and duration were improved. Also, the percentage of drug-drug interaction was reduced significantly after intervention (53.2% vs. 34.7%, p<O.OOl).
CONCLUSION: The appropriateness of using fluoroquinolones was improved through the educational interventions and pharmacists'' consultations. However, the rate of compliance with the Use Criteria of Fluoroquinolones was unsatisfactory. Therefore, it is necessary to reinforce the intervention action in the future to ameliorate the use of fluoroquinolones.
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