Strategies to improve antibiotic use.

The desideratum of "appropriate" antibiotic therapy include efficacy, safety, and low cost. Strategies for achieving these goals include education, control of the hospital formulary, written justification forms and automatic stop orders, ongoing utilization review, restriction, required consultation, control of laboratory susceptibility testing, and limitation of contact time between physicians and pharmaceutical representatives. Because traditional education methods have had limited impact on "appropriate" antibiotic use, the potential of the newer strategies must be explored. Most published studies emanate from teaching hospitals, leaving the applicability of the findings to community hospitals largely unsettled. At each hospital, it should be determined which combination of strategies will strike the best balance between effectiveness and palatability. Computer technology continues to hold promise as a way to provide instantaneous, nonthreatening feedback to prescribing physicians.