Strategies to Address Appropriate Fluoroquinolone Use in the Hospital

Abstract

Purpose Strategies to optimally use fluoroquinolones in the hospital setting are reviewed. Summary Fluoroquinolones possess broad-spectrum antimicrobial coverage and are widely used to treat a variety of infections including some serious, life-threatening conditions. Overuse and inappropriate use of fluoroquinolones has led to rapid emergence of fluoroquinolone-resistant organisms as well as multidrug-resistant pathogens. Preserving the fluoroquinolone class is important, especially given the lack of new antibiotics currently in clinical development. Maintaining the fluoroquinolone class as a therapeutic option requires the successful implementation of guidelines to promote appropriate, optimal use of these agents. Among many recommendations to control the growing problem of antimicrobial resistance, antimicrobial stewardship programs offer the most comprehensive solution to gain appropriate antimicrobial prescribing. Effective programs include selection of the most effective agents, specific dosages, frequency of administration, routes of administration, and duration of therapy. Additionally, a dual fluoroquinolone formulary, which typically incorporates one respiratory fluoroquinolone and ciprofloxacin, has been employed to increase the diversity of fluoroquinolone treatment and thus reduce the selective antimicrobial pressure. A combination of antimicrobial stewardship programs and a dual formulary option has been demonstrated to be a good approach to optimize the use of fluoroquinolones in the hospital. Two successful experiences in applying such strategies have been reported; in both cases the empiric fluoroquinolone prescribing was reduced. Conclusion Implementation of aggressive optimization strategies such as the combined use of antimicrobial stewardship programs and a dual fluoroquinolone formulary may maintain the efficacy of fluoroquinolones and preserve their utility for future patients.