Drug Utilization Study of Fluoroquinolones Before and After JCI Accreditation

OBJECTIVE To learn the changes in rationality of fluoroquinolones use during the national program of antibiotics stewardship and Joint Commission International accreditation. METHODS The retrospective analysis was performed on antibacterial use and bacterial resistance rate of acinetobacter baumanii(Ab), pseudomonas aeruginosa(Pa), Klebsiella pneumonia(Kp) and Escherichia coli(Ec), appropriateness of levofloxacin use in inpatients and fluoroquinolones- related medication errors during 2009-2013. RESULTS Decreasing trend was observed in the use intensity of anti-Gram- negative bacteria agents. The continuous decrease in resistance rate was observed with Ab, Kp and Ec against ciprofloxacin and levofloxacin, and Pa against levofloxacin. The use intensity of fluoroquinolones decreased year by year and it was positively correlated with resistance rate of four bacterial against ciprofloxacin, levofloxacin, piperacillin sodium/tazobactam sodium, Pa against ceftazidime, cefepime, imipenem and meropenem. Compared with levofloxacin and moxifloxacin, ciprofloxacin exhibited little correlation between its use intensity and bacterial resistance rate. The ratio of intravenous route to oral route of levofloxacin decreased significantly(P<0.05) and dose adjustment based on creatinine clearance rate increased significantly(P<0.05). The 97.2% of fluoroquinolones-related medication errors were efficiently intercepted by auditing pharmacists. CONCLUSION The rationality of fluoroquinolones clinical use improves significantly. Fluoroquinolones have complicated relationships with other antibacterials with respect to bacterial resistance. Control of overusing fluoroquinolones may positively affect the bacterial resistance of other antibacterials. However, different fluoroquinolones may have different influences on the bacterial resistance.