Results of an antimicrobial control program at a university hospital.
OBJECTIVE
The results of the first five years of an ongoing antimicrobial control program are reported.


METHODS
In 1998, a multidisciplinary antimicrobial subcommittee of the pharmacy and therapeutics committee of a university hospital was formed and charged with making formulary interventions in an effort to reduce rising antimicrobial resistance rates and drug expenditures. In 1999, a number of measures were implemented for controlling antimicrobial use. Selected antimicrobials with the potential for inappropriate use or whose inappropriate use had been documented were placed in the control of physicians in the infectious diseases (ID) division. Prior approval by an ID physician was required before the pharmacy could dispense these agents. Other key interventions included removal of ceftazidime and cefotaxime from the formulary, restriction of vancomycin and carbapenem use, and replacement of ciprofloxacin with levofloxacin as the sole fluoroquinolone on the formulary. Data regarding antimicrobial use and expenditures between 1998 and 2002 were compared and analyzed.


RESULTS
Antimicrobial use was reduced by 80% for third-generation cephalosporins and 15% for vancomycin following the implementation of the new antimicrobial policies. Antimicrobial-resistance patterns for many important gram-negative pathogens, including Pseudomonas aeruginosa, demonstrated a reversal of previous increases. In addition, the rate of methicillin-resistant Staphylococcus aureus decreased by an average of 3% each year from 1999 to 2002. Pharmacy expenditures for all antimicrobials, including antiviral, antifungal, and antibacterial agents, decreased 24.7%, with a cumulative cost saving of 1,401,126 US dollars, without inflation assumptions.


CONCLUSIONS
The implementation of an antimicrobial control program decreased the use of selected antimicrobial agents and resulted in substantial reduction of expenditures for antimicrobials.
Martin
Craig
C
University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA. cmart2@email.uky.edu
Ofotokun
Ighovwerha
I
Rapp
Robert
R
Empey
Kerry
K
Armitstead
John
J
Pomeroy
Claire
C
Hoven
Ardis
A
Evans
Martin
M
D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use*; D016527:Drug Costs; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review; D005572:Formularies, Hospital as Topic; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D010606:Pharmacy and Therapeutics Committee; D011785:Quality Assurance, Health Care
D000890:Anti-Infective Agents