Document Detail

Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital.
MedLine Citation:
PMID:  20358404     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study measured the impact of three interventions for physicians, in order to implement guidelines for sequential therapy (intravenous to oral conversion) with fluoroquinolones.
SETTING: A Belgian university hospital with 1,065 beds. Method The first intervention consisted of the hospital-wide publication of guidelines in the local drug letter towards all prescribers. The consumption of fluoroquinolones was measured by means of an interrupted time-series (ITS) analysis 21 months before (period A) and 24 months after publication (period B). The second intervention was an educational interactive session, by infectious disease specialists, to the medical staff of orthopaedics and endocrinology. The third intervention comprised a proactive conversion programme on the abdominal surgery, gastro-enterology and plastic surgery wards, where pharmacists attached a pre-printed note with a suggestion to switch to an oral treatment every time a patient met the criteria for switching. The second and third intervention took place 6 months after the first intervention. Fluoroquinolone treatments were evaluated during a 2 month period before (group 1) and after the introduction of the second (group 2) and third (group 3) intervention.
MAIN OUTCOME MEASURE: The monthly ratio of intravenous versus total fluoroquinolone consumption (daily defined doses per 1,000 bed days) was measured to assess the impact of the first intervention. The impact of the second and third intervention was measured in relation to the number of days that intravenous therapy continued beyond the day that the patient fulfilled the criteria for sequential therapy and the antibiotic cost.
RESULTS: The ITS demonstrated a reduction of 3.3% in the ratio of intravenous versus total consumption after the publication of the guidelines (P = 0.011). In group 1, patients were treated intravenously for 4.1 days longer than necessary. This parameter decreased in group 2 to 3.5 days and in group 3 to 1.0 day (P = 0.006). The mean additional cost for longer intravenous treatment decreased from 188.0 euro in group 1, to 103.0 euro in group 2 and 44.0 euro in group 3 (P = 0.037).
CONCLUSION: This study demonstrated that active implementation of guidelines is necessary. A proactive conversion programme by a pharmacist resulted in a reduction in the duration of the intravenous treatment, and the treatment cost.
Franky Buyle; Dirk Vogelaers; Renaat Peleman; Georges Van Maele; Hugo Robays
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-04-01
Journal Detail:
Title:  Pharmacy world & science : PWS     Volume:  32     ISSN:  1573-739X     ISO Abbreviation:  Pharm World Sci     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2011-01-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9307352     Medline TA:  Pharm World Sci     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  404-10     Citation Subset:  IM    
Pharmacy Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
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MeSH Terms
Drug Prescriptions / economics,  standards*
Fluoroquinolones / therapeutic use*
Hospitals, University / economics,  standards*
Medication Systems, Hospital / economics,  standards*
Middle Aged
Pharmacists / standards*
Practice Guidelines as Topic / standards*
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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