Posted by James
Many factors, such as patient acuity, number of intensive care beds, and patient demographic characteristics, can confound differences in utilization rates of antimicrobials across different facilities; therefore, comparisons between hospitals and districts should be used only as a guide. There was a nonsignificant trend for small hospitals to have higher use of fluoroquinolones than large hospitals, which suggests overuse of these drugs by some facilities.
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Posted by James
The advantages of stepping down from IV to oral therapy include lower cost, less administration time by nursing staff, decreased length of stay, and decreased potential for adverse events associated with IV therapy. One possible reason for the trend of decreasing oral usage may be the decline in hospital length of stay. Patients are typically switched to oral therapy just before discharge, and oral therapy continues on an outpatient basis; however, outpatient therapy was not included in this study. Another reason may be that patients who were admitted later in the study period were sicker, and their care was more complex, than patients admitted earlier in the study period.
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Posted by James
Total annual use of all fluoroquinolones increased significantly over the study period. This corroborates other antimicrobial utilization studies, which showed an overall decrease in consumption of antimicrobials but an increase in fluoroquinolone use in Canada from 1995 to 1998. The total fluoroquinolone use reported here (mean of 163.8 DDDs/1000 bed-days for 2002/2003) was similar to that reported for 42 hospitals in the United States (mean of 150 DDDs/1000 bed-days for 2003). There is evidence to suggest that increased bacterial resistance is correlated with increased use of antimicrobials. According to the Canadian Bacterial Surveillance Network, resistance to fluoroquinolones is increasing in Canada. Between 1993 and 1998, resistance of Streptococcus pneumoniae to fluoroquinolones increased from 1.5% to 2.9%, which coincided with an increase in the number of prescriptions for ciprofloxacin during the same period. Rates of resistance to fluoroquinolones are still low; however, as the use of these agents increases, resistance is expected to increase as well.
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Posted by James
Effect of Utilization Policies
All of the 9 surveys that were mailed (one to each DHA) were returned, for a 100% response rate. The types of policies in place and how they were enforced and audited varied widely among the 9 DHAs (Table 2). Combining the survey results with the fluoroquinolone utilization data provided additional insights into drug utilization policies in Nova Scotia. Student ttests comparing drug utilization rates between hospitals with no utilization policies and those with more than one policy revealed no statistically significant differences in the use of ciprofloxacin (p = 0.20) or levofloxacin (p = 0.38).
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Posted by James
Norfloxacin and Ofloxacin
Norfloxacin use decreased by 86.8% over the study period (p < 0.001) (Table 1). Use of ofloxacin was limited, and no trends were evident (Table 1).
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Posted by James
Over the 6-year study period, a total of 31 hospitals administered fluoroquinolones, and there were 169 hospital-year observations. Because hospitals with fewer than 10 acute care beds were excluded, data from only 27 hospitals (with 149 hospital-year observations) were examined in the final analysis.
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Posted by James
Data Analysis
All hospitals that had purchased the fluoroquinolones investigated in this study and that had admitted patients with community-acquired pneumonia were included in the study. All statistical analyses were restricted to hospitals with at least 10 acute care beds (to reduce statistical bias). Provincial drug purchasing data were aggregated using the WHO ATC/DDD classification system (2003 edition) for the fiscal years 1997/1998 to 2002/2003. Raw data were coded and computed using a standard spreadsheet program (Office 97 Excel, Microsoft, Redmond, Washington). Drugs were classified and volume data were transformed to ATC/DDD values. Values for utilization of fluoroquinolones were expressed as number of DDDs per 1000 (acute care) bed-days per year and number of
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