Optimising use of ciprofloxacin in a large teaching hospital: sustained effect of a prospective intervention study

Abstract number: 1732_102

van Hees B., de Ruiter E., Wiltink E., de Jongh B., Tersmette M.

Objective: Antimicrobial resistance to ciprofloxacin, a valuable second-line antibiotic, is increasing. To limit this increase the appropriate use of ciprofloxacin should be encouraged. The objective of this study was to reduce the number of inappropriate prescriptions and improve the quality of ciprofloxacin prescriptions by way of educational intervention.

Methods: Five units (197 beds) of the departments of Internal Medicine, Gastro-Enterology, Surgery, Urology and Pulmonary Diseases, selected because of a high rate of ciprofloxacin prescription, participated in a prospective intervention study. The study comprised three periods of three months: 2 observation periods (phase 1 and 3) and an intervention period (phase 2). A follow up of 3 months was done 9 months after start of intervention. During the two observation periods all ciprofloxacin prescriptions were registered and the quality of each ciprofloxacin prescription was evaluated in a standardised manner by two experts in infectious diseases independently. During the intervention period physicians prescribing ciprofloxacin were interviewed by a medical microbiologist, and educational presentations were given to physicians of the participating units.

Results: During phase 1 491 prescriptions per 1000 admissions of ciprofloxacin were written, declining to 184 prescriptions per 1000 admissions in phase 3, a reduction of 62.5%. The greatest reduction was observed in units of the Departments of Surgery and Urology (83.9% and 75.6% respectively), mainly due to a reduction of erratic prophylactic use. Unjustified prescriptions (no use of antibiotics indicated) decreased with 25.9%. Inappropriate prescriptions (wrong choice of antibiotic or duration of prescription) declined from 69.5% to 57.7%, mainly due to the decrease of ciprofloxacin courses of too long duration. Appropriate prescriptions increased with 33.5%. Nine months after intervention 136 prescriptions per 1000 admissions of ciprofloxacin were prescribed, a total reduction of 72.3%.

Conclusion: Intervention by direct consultation of a medical microbiologist and educational presentations led to significant reduction of the use of ciprofloxacin and improvement of the quality of ciprofloxacin prescription. Nine months after the intervention the use of ciprofloxacin had declined even further, indicating a sustained effect of the intervention measures.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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