Abstract
Antibiotics are often misused, resulting in a high frequency of adverse effects, emergence of drug‐resistant organisms, and excessive costs. The high cost of antibiotics is currently receiving the greatest attention. Considerable cost savings can be achieved by appropriate prescribing of antibiotics for patients receiving these drugs prophylactically as well as for those with established infections. This article cites specific examples of how cost‐effective antibiotic prescribing practices can realize substantial cost savings without any diminished quality in patient care.
References
- 1. Green JW, Wenzel RP. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct costs of hospitalization. Ann Surg 1977;185: 264–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Howard JM, Barker WF, Culbertson WR et al. Postoperative wound infections: the influence of ultraviolet irradiation on the operating room and of various other factors. Ann Surg 1964;160(suppl): 32–81. [PubMed] [Google Scholar]
- 3. Ehrenkranz NJ. Surgical wound infection occurrence in clean operations. Am J Med 1981;70: 909–14. [DOI] [PubMed] [Google Scholar]
- 4. Gleckman R, Gantz NM. The third‐generation cephalosporins: a plea for restraint. Arch Intern Med 1982;142: 1267–8. [PubMed] [Google Scholar]
- 5. Shapiro M, Townsend TR, Rosner B et al. Use of antimicrobial drugs in general hospitals: patterns of prophylaxis. N Engl J Med 1979;301: 351–5. [DOI] [PubMed] [Google Scholar]
- 6. Kaplan EL, Anthony BR, Bisno A et al. Prevention of bacterial endocarditis. Circulation 1977;56: 139A–143A. [PubMed] [Google Scholar]
- 7. Kunin CM, Tupasi T, Craig WA. Use of antibiotics: a brief exposition of the problem and some tentative solutions. Ann Intern Med 1973;79: 555–60. [DOI] [PubMed] [Google Scholar]
- 8. Simmons HE, Stolley PD. This is medical progress? Trends and consequences of antibiotic use in the United States. JAMA 1974;227: 1023–8. [DOI] [PubMed] [Google Scholar]
- 9. Maki DG, Schuna AA. A study of antimicrobial misuse in a university hospital. Am J Med Sci 1978;275: 271–82. [DOI] [PubMed] [Google Scholar]
- 10. Gleckman R. The controversy of treatment of asymptomatic bactehuria in nonpregnant women‐resolved. J Urol 1976;116: 776–7. [DOI] [PubMed] [Google Scholar]
- 11. Tager IB, Speizer FE. Role of infection in chronic bronchitis. N Engl J Med 1975;292: 563–71. [DOI] [PubMed] [Google Scholar]
- 12. Nicotra MB, Rivera M, Awe RJ. Antibiotic therapy of acute exacerbations of chronic bronchitis. A controlled study using tetracycline. Ann Intern Med 1982;97: 563–71. [DOI] [PubMed] [Google Scholar]
- 13. Meislin HW, Lerner SA, Graves MH et al. Cutaneous abscesses. Ann Intern Med 1977;87: 145–9. [DOI] [PubMed] [Google Scholar]
- 14. Fang LST, Rubin NET, Rubin RH. Clinical management of urinary tract infection. Pharmacotherapy 1982;2: 91–9. [DOI] [PubMed] [Google Scholar]
- 15. Rahal JJ Jr. Antibiotic combinations: the clinical relevance of synergy and antagonism. Medicine 1978;57: 179–95. [PubMed] [Google Scholar]
- 16. Harding GKM, Buckwold FJ, Ronald AR et al. Prospective, randomized, comparative study of clindamycin, chloramphenicol, and ticarcillin, each in combination with gentamicin, in therapy for intraabdominal and female genital tract sepsis. J Infect Dis 1980;142: 384–93. [DOI] [PubMed] [Google Scholar]
- 17. Scheife RT, Tally FP, McGowan K at al Cost comparison of two antimicrobial regimens for treating mixed aerobic‐anaerobic infections. Am J Hosp Pharm 1981;38: 1466–9. [PubMed] [Google Scholar]
- 18. Drusano GL, Warren JW, Saah AJ. A prospective randomized controlled trial of cefoxitin versus clindamycin‐aminoglycoside in mixed anaerobic‐aerobic infections. Surgery 1982;154: 715–20. [PubMed] [Google Scholar]
- 19. Feigin RD, Pickering LK, Anderson D et al. Clindamycin treatment of osteomyelitis and septic arthritis in children. Pediatrics 1975;55: 213–23. [PubMed] [Google Scholar]
- 20. Tetzlaff TR, McCracken GH, Nelson JD. Oral antibiotic therapy for skeletal infections of children. II. Therapy of osteomyelitis and suppurative arthritis. J Pediatr 1978;92: 485–90. [DOI] [PubMed] [Google Scholar]
- 21. Bryson YJ, Connor JD, LeClerc M et al. High‐dose dicloxacillin treatment of acute staphylococcal osteomyelitis in children. J Pediatr 1979;94: 673–5. [DOI] [PubMed] [Google Scholar]
- 22. Dunkle LM, Brock N. Long‐term follow‐up of ambulatory management of osteomyelitis. Clin Pediatr 1982;21: 650–5. [DOI] [PubMed] [Google Scholar]
- 23. Walker SH. Staphylococcal osteomyelitis in children. Success with cephalordine‐cephalexin therapy. Clin Pediatr 1973;12: 98–100. [DOI] [PubMed] [Google Scholar]
- 24. Prober CG, Yeager AS. Use of the serum bactericidal titer to assess the adequacy of oral antibiotic therapy in the treatment of acute hematogenous osteomyelitis. J Pediatr 1979;95: 131–5. [DOI] [PubMed] [Google Scholar]
- 25. Kolyvas E, Ahronheim G, Marks MI et al. Oral antibiotic therapy of skeletal infections in children. Pediatrics 1980;65: 867–71. [PubMed] [Google Scholar]
- 26. Prober CG. Oral antibiotic therapy for bone and joint infections. Pediatr Infect Dis 1982;1: 8–10. [DOI] [PubMed] [Google Scholar]
- 27. Abraham E, Baraff LJ. Oral versus parenteral therapy of pyelonephritis. Curr Ther Res 1982;31: 536–42. [Google Scholar]
- 28. Shank WA, Amerson AB. Metronidazole: an update on its expanding role in clinical medicine. Hosp Form 1981;16: 283–97. [Google Scholar]
- 29. Anon. For how long should antimicrobial therapy continue (editorial). J Infect 1980;2: 299–301. [DOI] [PubMed] [Google Scholar]
- 30. Neu HC. Current practices in antimicrobial dosing. Rev Infect Dis 1981;3: 12–8. [DOI] [PubMed] [Google Scholar]
- 31. Fang LST, Rubin NET, Rubin RH. Efficacy of single‐dose and conventional amoxicillin in urinary‐tract infections localized by the antibody coated bacteria technique. N Engl J Med 1978;298: 413–6. [DOI] [PubMed] [Google Scholar]
- 32. Lossick JG. Treatment of Trichomonas vaginalis infections. Rev Infect Dis 1982;4(suppl): 801–18. [Google Scholar]
- 33. Thompson SE III. Treatment of disseminated gonococcal infections. Sex Trans Dis 1979;6(suppl): 181–4. [DOI] [PubMed] [Google Scholar]
- 34. Thompson SE III. Gonococcal tenosynovitis‐dermatitis and septic arthritis. JAMA 1980;244: 1101–2. [PubMed] [Google Scholar]
- 35. Anon. Sexually transmitted diseases treatment guidelines. Morbidity Mortalilty Weekly Reports 1982;31(suppl): 335–605. [PubMed] [Google Scholar]
- 36. Dutt AK, Jones L, Stead WW. Short‐course chemotherapy for tuberculosis with largely twice‐weekly isoniazid‐rifampin. Chest 1979;75: 441–7. [DOI] [PubMed] [Google Scholar]
- 37. British Thoracic Association. A controlled trial of six months chemotherapy in pulmonary tuberculosis. Second report: Results during the 24 months after the end of chemotherapy. Am Rev Resp Dis 1982;126: 460–2. [DOI] [PubMed] [Google Scholar]
- 38. Anon. Guidelines for short‐course tuberculosis chemotherapy. Morbidity Mortality Weekly Reports 1980;29: 97–105. [Google Scholar]
- 39. Wilson WR, Geraci JE. Antimicrobial therapy for penicillin‐sensitive streptococcal infective endocarditis: Two‐week regimens In: Bisno AL. ed. Treatment of infective endocarditis. New York: Grune and Stratton, 1981: 61–73. [Google Scholar]
- 40. Tan JS, Terhune CA Jr, Kaplan S et al: Successful two‐week treatment schedule for penicillin‐susceptible streptococcus viridans endocarditis. Lancet 1971;2: 1340–3. [DOI] [PubMed] [Google Scholar]
- 41. 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: 935–8. [DOI] [PubMed] [Google Scholar]
- 42. Dudley M, Barriere S. Cost comparisons among antimicrobial agents (letter). N Engl J Med 1982;307: 689. [DOI] [PubMed] [Google Scholar]
- 43. Rucker RW, Harrison GM. Outpatient intravenous medications in the management of cystic fibrosis. Pediatrics 1974;54: 358–60. [PubMed] [Google Scholar]
- 44. Poretz DM, Eron LJ, Goldenberg RI et al. Intravenous antibiotic therapy in an outpatient setting. JAMA 1982;248: 336–9. [PubMed] [Google Scholar]
- 45. Stiver HG, Telford GO, Mossey JM et al. Intravenous antibiotic therapy at home. Ann Intern Med 1978;89: 690–3. [DOI] [PubMed] [Google Scholar]
- 46. Antoniskis A, Anderson BC, Volkinburg JV et al. Feasibility of outpatient self‐administration of parenteral antibiotics. West J Med 1978;128: 203–6. [PMC free article] [PubMed] [Google Scholar]
- 47. Williams DN, Kind AC, Gibson JA et al. Outpatient intravenous antibiotics experience with 65 patients. Am J Intrav Ther Clin Nutr 1982;9: 33–40. [Google Scholar]
- 48. Kind AC, Williams DN, Persons G et al. Intravenous antibiotic therapy at home. Arch Intern Med 1979;139: 413–5. [PubMed] [Google Scholar]
- 49. Swenson JD. Training patients to administer intravenous antibiotics at home. Am J Hosp Pharm 1981;38: 1480–3. [PubMed] [Google Scholar]
- 50. Stiver HG, Trosky SK, Cote DD et al. Self‐administration of intravenous antibiotics: an efficient, cost‐effective home care program. CMA J 1982;127: 207–11. [PMC free article] [PubMed] [Google Scholar]
- 51. Frame PT. Outpatient intravenous antibiotic therapy (editorial). JAMA 1982;248: 356. [PubMed] [Google Scholar]
- 52. Kunin CM. Evaluation of antibiotic usage: A comprehensive look at alternative approaches. Rev Infect Dis 1981;3: 745–53. [DOI] [PubMed] [Google Scholar]
- 53. Cooke D, Salter AJ, Phillips I. Antimicrobial misuse, antibiotic policies and information resources. J Antimicrob Chemother 1980;6: 435–43. [DOI] [PubMed] [Google Scholar]
- 54. Jones SR, Barks J, Bratton T. The effect of an educational program upon hospital antibiotic use. Am J Med Sci 1977;273: 79–85. [DOI] [PubMed] [Google Scholar]
- 55. Zeman BT, Pike M, Samet C. The antibiotic utilization committee: An effective tool in the implementation of drug utilization review that monitors the medical justification and cost of antibiotic use. JAMA 1974;48: 73–6. [PubMed] [Google Scholar]
- 56. McGowan JE Jr, Finland M. Infection and antibiotic usage at Boston City Hospital: Changes in prevalence during the decade 1964‐1973. J Infect Dis 1974;129: 421–8. [DOI] [PubMed] [Google Scholar]
- 57. McGowan JE Jr, Finland M. Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974;130: 165–8. [DOI] [PubMed] [Google Scholar]
- 58. Durbin WA Jr, Lapidas B, Goldmann DA. Improved antibiotic usage following introduction of a novel prescription system. JAMA 1981;246: 1796–1800. [PubMed] [Google Scholar]
- 59. Kunin CM, Efron HY. Guidelines for peer review, Veterans Administration Ad Hoc Interdisciplinary Advisory Committee on Antimicrobial Use, Audits of Antimicrobial Usage. JAMA 1977;237: 1001–7, 1134–7, 1241–5, 1366–9, 1481–4, 1605–8, 1723–5, 1859, 1860, 1967, 1968, 1968‐70. [PubMed] [Google Scholar]
- 60. Counts GW. Review and control of antimicrobial usage in hospitalized patients. JAMA 1977;238: 2170–2. [PubMed] [Google Scholar]