title: Evaluation of new antimicrobials for the hospital formulary. Policies restricting antibiotic use in hospitals.
abstract: In Spain, the inclusion of new antibiotics in hospital formularies is performed by the Infection Policy Committee or the Pharmacy and Therapeutic Committee, although now the decision is moving to a regional level. Criteria for the evaluation of new drugs include efficacy, safety and cost. For antimicrobial drugs evaluation it is necessary to consider local sensibility and impact in bacterial resistance to determinate the therapeutic positioning. There is compelling evidence that the use of antibiotics is associated with increasing bacterial resistance, and a great number of antibiotics are used incorrectly. In order to decrease the inappropriate use of antibiotics, several approaches have been proposed. Limiting the use of antimicrobials through formulary restrictions, often aimed at drugs with a specific resistance profile, shows benefits in improving antimicrobial susceptibilities and decreasing colonization by drug-resistant organisms. However, the restriction of one agent may result in the increased utilization of other agents. By using antibiotic cycling, the amount of antibiotics is maintained below the threshold where bacterial resistance develops, thus preserving highly efficient antibiotics. Unfortunately, cumulative evidence to date suggests that antibiotic cycling has limited efficacy in preventing antibiotic resistance. Finally, although there is still little clinical evidence available on antibiotic heterogeneity, the use of most of the existing antimicrobial classes could limit the emergence of resistance. This review summarizes information regarding antibiotic evaluation and available restrictive strategies to limit the use of antibiotics at hospitals with the aim of curtailing increasing antibiotic resistance.
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain. Electronic address: mpujol@bellvitgehospital.cat.
authors.forename: Miquel
authors.initials: M
authors.lastname: Pujol
authors.forename: Olga
authors.initials: O
authors.lastname: Delgado
authors.forename: Francesc
authors.initials: F
authors.lastname: Puigventós
authors.forename: Juan E
authors.initials: JE
authors.lastname: Corzo
authors.forename: Emilia
authors.initials: E
authors.lastname: Cercenado
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Martínez
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000592:standards*; D005572:Formularies, Hospital as Topic; D006761:Hospitals; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Antimicrobial stewardship programs (ASP); Antimicrobial use; Políticas restrictivas de uso de antibióticos; Programas de optimización del uso de antibióticos; Resistencia antibiótica; Restrictive antimicrobial policies; Uso de antibióticos