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Improving fluoroquinolone use in the outpatient setting using a patient safety initiative

  • Kazuaki Jindai (a1) (a2), Michihiko Goto (a3) (a4), Kimberly MacKay (a2), Graeme N. Forrest (a2) (a5), Jackson Musuuza (a6), Nasia Safdar (a7) (a8) and Christopher D. Pfeiffer (a2) (a5)...


We analyzed the impact of a fluoroquinolone patient safety initiative on the weekly fluoroquinolone prescription rate in Veterans Affairs community-based outpatient clinics. We observed a significant initial but unsustained reduction. Such an initiative can function as an antimicrobial stewardship intervention; however, strategies to promote sustainability should be explored.


Corresponding author

*Author for correspondence: Kazuaki Jindai, MD, MPH, 1-2-2 Kasumigaseki, Chiyoda-ku, Tokyo, 100-8916 Japan. E-mail:


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Present affiliation: K.J. is now affiliated with Infectious Disease Control Division, Health Service Bureau, Ministry of Health, Labour and Welfare, Tokyo, Japan.



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4. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. US Food and Drug Administration website. Published 2016. Accessed January 30, 2018.
5. Department of Veterans Affairs Office of Inspector General. Community Based outpatient clinic and primary care clinic reviews at Portland VA Medical Center Portland, Oregon. Department of Veterans Affairs website. Published 2014. Accessed April 1, 2017.
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8. Gerber, JS, Prasad, PA, Fiks, AG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA 2013;309:23452352.
9. Suda, KJ, Hicks, LA, Roberts, RM, Hunkler, RJ, Taylor, TH. Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents Chemother 2014;58:27632766.
10. Ancker, JS, Edwards, A, Nosal, S, et al. Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC Med Informat Decis Making 2017;17:36.


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