In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. 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. 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%. The interventions from this program provide data supporting the effectiveness of formulary changes and PAF for antimicrobial stewardship in a nontraditional care setting.
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