Antimicrobial stewardship in the Federal Bureau of Prisons: Combining prospective audit and feedback with formulary changes to reduce inappropriate fluoroquinolone use.

Abstract

Purpose: Antimicrobial stewardship programs have been widely implemented with positive results in the inpatient healthcare delivery model. However, data supporting these interventions is limited in other care settings.

Summary: Formulary restrictions and conducting prospective audit and feedback (PAF) are mainstays of antimicrobial stewardship. A PAF program targeted specifically at fluoroquinolone use was implemented in the Federal Bureau of Prisons (FBOP), in addition to exclusionary formulary restrictions on ciprofloxacin and levofloxacin. After implementation of these interventions, overall fluoroquinolone orders per 1,000 adults in custody (AICs) were reduced by 46.4% (P < 0.0001). The majority of PAF interventions addressed situations in which an antibiotic was unnecessary or a fluoroquinolone was not the recommended first-line agent. Over the same time period, nonformulary approval rates for ciprofloxacin and levofloxacin averaged 62%.

Conclusion: The interventions from this program provide data supporting the effectiveness of formulary changes and PAF for antimicrobial stewardship in a nontraditional care setting.