Abstract • Streamlining of antibiotic therapy from a more complex to a less complex regimen should reduce hospital costs. Utilizing the expertise of an infectious disease physician and clinical pharmacists, an antibiotic-streamlining program was implemented by (1) daily collection of data on patients receiving two or more parenteral antibiotics, (2) formulation of recommendations of cost-effective alternative therapy when clinically appropriate, (3) oral and/or written communication of the reasons for the recommendation to the patient's physician, (4) follow-up monitoring, and (5) determination of the cost savings by subtracting the actual cost of antibiotic therapy (including labor and supplies) from the cost of the initial regimen if it had been continued without alteration. Streamlining recommendations were made in 340 of 625 patients who were reviewed during the initial seven months. Cases that necessitated streamlining recommendations decreased from 98.6% during the first month to 54.4% during the seventh month, reflecting the educational impact of the program on prescribing habits. Recommendations were followed in 82.6% of the cases, of which 97.2% completed therapy with the streamlined regimen. The projected annual savings of the program was $107637. (Arch Intern Med 1988;148:2019-2022) References 1. Parr MD, Hansen LA, Waite WW, et al: Computer program for comparing total costs of intravenous antibiotic regimens. Am J Hosp Pharm 1986;43:2189-2193. 2. Rapp RP, Bannon CL, Bivins BA: The influence of dose frequency and agent toxicity on the cost of parenteral antibiotic therapy. Drug Intell Clin Pharm 1982;16:935-938. 3. Tanner DJ: Cost containment of reconstituted parenteral antibiotics: Personnel and supply costs associated with preparation, dispensing, and administration. Rev Infect Dis 1984;6:924-937.Crossref 4. Rinehart JR: P & T Committee antibiotic cost considerations. Hosp Form 1986;21:857-864. 5. Naylor H: Estimating the true cost of parenteral antibiotic therapy. Hosp Ther 1986;12:17-32. 6. Quintiliani R, Klimek JJ, Nightingale CH: Restriction policies for therapy with combination antibiotics. J Infect Dis 1986;153:645-647.Crossref 7. Weinstein MC, Read JL, MacKay DN, et al: Cost-effective choice of antimicrobial therapy for serious infections. J Gen Intern Med 1986;1:351-363.Crossref 8. Moore RD, Smith CR, Holloway JJ, et al: Cefotaxime vs nafcillin and tobramycin for the treatment of serious infection: Comparative cost-effectiveness. Arch Intern Med 1986;146:1153-1157.Crossref 9. Quintiliani R, Cooper BW, Briceland LL, et al: Economic impact of streamlining antibiotic administration. Am J Med 1987;82( (suppl 4A) ):391-395. 10. Abramowitz PW: Controlling financial variables—changing prescribing patterns. Am J Hosp Pharm 1984;41:503-515. 11. Phelps MR, Godwin HN: Pharmacy and Therapeutics Committee review of parenteral cephalosporins. Am J Hosp Pharm 1978;35:73-75. 12. Lawlor MC, Lucarotti RL: Clinical pharmacist impact on parenteral cephalosporin prescribing. Am J Hosp Pharm 1983;18:402-408. 13. Britton HL, Schwinghammer TL, Romano MJ: Cost containment through restriction of cephalosporins. Am J Hosp Pharm 1981;38:1897-1900. 14. Young LS: Empirical antimicrobial therapy in the neutropenic host. N Engl J Med 1986;315:580-581.Crossref 15. Pizzo PA, Hathorn JW, Hiemenz J, et al: A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 1986;315:552-558.Crossref 16. Dipiro JT, Mansberger JA, Davis JB: Current concepts in clinical therapeutics: Intra-abdominal infections. Clin Pharm 1986;5:34-50. 17. Smith CR, Ambinder R, Lipsky JJ, et al: Cefotaxime compared with nafcillin plus tobramycin for serious bacterial infections. Ann Intern Med 1984;101:469-477.Crossref 18. Lode H: Initial therapy in pneumonia. Am J Med 1986;80( (suppl 5C) ):70-74.Crossref
Archives of Internal Medicine – American Medical Association
Published: Sep 1, 1988
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