Vol.74 No.2 March 2026

Impact of antimicrobial stewardship on clinical pathway revision: discontinuation of oral levofloxacin in cataract surgery

Keiichi Sasaki^{1, 2)}, Yuta kondo¹⁾, Takafumi Nakashima¹⁾, Shigeru Ishida¹⁾, Yasushi Kibe³⁾, Risa Kobayashi²⁾, Takeshi Hirota¹⁾, Yusuke Murakami⁴⁾, Koh-Hei Sonoda⁴⁾, Mayako Uchida¹⁾ and Nobuyuki Shimono^{2, 5)}

¹⁾Department of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
²⁾Center for the Study of Global Infection, Kyushu University Hospital
³⁾Department of Clinical Laboratory, Kyushu University Hospital
⁴⁾Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University
⁵⁾Department of General Internal Medicine, Kyushu University Hospital

Abstract

In recent years, antimicrobial resistance (AMR) has become a global concern, prompting worldwide efforts towards judicious antimicrobial use. To promote more effective antibiotic stewardship (AS), it is essential for each medical institution to evaluate both process and outcome indicators, as outlined in the Guidance for Implementing Antibiotic Stewardship Programs in Japan. One of the standard AS interventions is the optimization of prophylactic antibiotic use in postoperative care, and regular revision of clinical pathways is considered an effective strategy for achieving this goal. At Kyushu University Hospital, a clinical pathway implemented for patients undergoing cataract surgery to ensure safe and standardized perioperative management includes the routine use of oral levofloxacin (LVFX) tablet during the perioperative period. This resulted in the Department of Ophthalmology recording the highest LVFX usage among all departments at the hospital. In this study, we revised this clinical pathway for cataract surgery by recommending discontinuation of LVFX use and evaluated the impact of this intervention on the postoperative outcomes of cataract surgery and antimicrobial usage at the Department of Ophthalmology. Notably, no cases of postoperative endophthalmitis were documented either in the year before or the year after the intervention. Furthermore, significant reductions were observed in the antimicrobial use density, days of therapy, and number of patients prescribed LVFX (all p<0.0001) at the department. The total number of LVFX tablets dispensed decreased from 8,896 to 324, resulting in a drug cost saving of 317,164 yen. These findings suggest that revision of the clinical pathway to remove routine LVFX use in the perioperative period reduced unnecessary antimicrobial use without affecting the incidence of postoperative endophthalmitis following cataract surgery, thereby contributing to AMR prevention efforts in Japan.

Key word

antimicrobial stewardship, clinical pathway, levofloxacin, postoperative endophthalmitis, surgical site infection

Received

August 8, 2025

Accepted

October 28, 2025

Jpn. J. Chemother. 74 (2): 135-141, 2026