Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including Clostridium difficile infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD ϭ 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD ϭ 6.4) DOT/1,000 PD and 4.8 (SD ϭ 3.6) DOT/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT/1,000 PD per month decrease; P ϭ 0.023) and restriction (24.5 DOT/1,000 PD per month decrease; P Ͻ 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly (P ϭ 0.044) from preintervention using education (3.43 cases/10,000 PD) and restriction (2.2 cases/10,000 PD). Mean monthly CDI cases/10,000 PD decreased from 4.0 (SD ϭ 2.1) preintervention to 2.2 (SD ϭ 1

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Cefazolin was non-inferior to ceftriaxone with regard to clinical response for the treatment of hospitalized patients with acute pyelonephritis in this study. No difference was observed for length of stay or 30 day readmission.

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