2077. Fluoroquinolone Usage Reduction in the Outpatient Setting

BACKGROUND: Fluoroquinolones (FQs) are the third most commonly prescribed outpatient antibiotic due to ease of dosing, broad spectrum of activity, and favorable pharmacokinetics. However, since 2016, the Food and Drug Administration (FDA) has released warnings about adverse effects, concluding that risks outweigh benefits especially for uncomplicated sinusitis, bronchitis, and cystitis. In fall 2016, our antimicrobial stewardship team began an initiative to decrease outpatient FQ usage involving provider education, addition of FDA warnings to oral FQ orders in Epic, and suppression of FQ susceptibilities. This evaluated the effectiveness of these initiatives in decreasing inappropriate outpatient FQ usage. METHODS: Retrospective chart review of FQ prescription was performed on all outpatient clinic, emergency department (ED), and urgent care emergency center (UCEC) visits during October 2016, 2017, and 2018. Inappropriate use was defined as an indication for cystitis, bronchitis, or sinusitis without a history of Pseudomonas aeruginosa or other multi-drug-resistant organism, or drug allergies precluding the use of non-FQs. RESULTS: 1,033 outpatient FQ prescriptions were reviewed. Total FQ prescribing decreased 34% from 405 in October 2016 to 267 in October 2018, with the proportion of inappropriate FQ use decreasing from 53% to 34%. Over 90% of the inappropriate FQ use was for cystitis. Inappropriate prescribing for cystitis and sinusitis decreased by 58% and 33%, respectively, but increased for bronchitis by 25%. The outpatient clinics, ED, and UCEC saw declines in the percentage of inappropriate FQ use of 10%, 15% and 22%, respectively, from October 2016 to October 2018. Despite these decreases, rates of inappropriate FQ utilization for the outpatient clinics, ED, and UCEC were 64%, 25%, and 31%, respectively, at the end of the last study period. CONCLUSION: A multi-modal FQ stewardship initiative effectively reduced the volume of outpatient FQ utilization and inappropriate FQ usage. Continued efforts to educate providers about the risks of FQ use and implement system-level initiatives are likely necessary to improve the rates of appropriate use and sustain the effects demonstrated in this study, especially for primary care providers in the outpatient setting. DISCLOSURES: All authors: No reported disclosures.