Ciprofloxacin Drug Utilization Review and Prospective Drug use Evaluation

Abstract

Ciprofloxacin is a fluoroquinolone antimicrobial with activity against both gram-negative and -positive bacteria including pseudomonal and staphylococcal species. It is the only available oral agent possessing this unique spectrum of activity that achieves serum concentrations adequate to treat a variety of systemic infections. A retrospective drug utilization review and a prospective drug use evaluation of ciprofloxacin were performed to determine if the agent was being used for appropriate indications, to ensure correct dosing and appropriate monitoring, and to determine whether its use is cost effective at the Veterans Administration Medical Center, Cleveland (VAMCC).

For the retrospective review, 40 patients’ charts were randomly chosen for review from computerized inpatient and outpatient prescription records. Drug use review criteria were developed by the Pharmacy Service and Infectious Disease Section. For the prospective evaluation, data were collected for all inpatient and outpatient requests for ciprofloxacin during a six-month period (May to November 1988) using the same criteria as in the retrospective study. Cost analysis was performed by identification and cost comparison of alternative therapy and by estimating the number of days saved by using appropriate oral therapy.

All charts from the retrospective review were found to meet criteria for appropriate use. All patients for whom documented follow-up was performed had microbiologic or clinical cures. In the prospective evaluation, 168 patients were started on ciprofloxacin. Ninety-five percent of patients had appropriate justification for use according to criteria. Drug cost savings for the six-month period was $14 962.54 or $29 925.08/year. This covered drug and minibag acquisition costs only. An estimated 127 hospital days were saved (shortened length of stay) in the six-month study period which provided a cost savings of $71 717.00 or $143 434.00/year. The total yearly savings of drug cost plus length of stay was $173 359.16.

Ciprofloxacin was found to be a cost-saving agent at the VAMCC in terms of actual drug costs and in decreasing length of hospitalization. With clinical pharmacy service intervention, ciprofloxacin can be a cost-effective agent in large medical centers.