Economic impact of oral ciprofloxacin. A pharmacist's perspective.

With increasing numbers of patients covered under diagnostic-related group or prospective payment systems, there is mounting pressure to reduce the costs associated with caring for patients while maintaining the quality of care. New, broad-spectrum, parenteral antimicrobial agents are a prime target for cost control. The availability of an orally administered drug that is effective in a variety of serious infections would have a significant impact on cost reduction in hospitals. A significant proportion of the cost of parenteral drug therapy is associated with labor, supplies, and equipment. An orally administered drug would obviate these costs. Additionally, iatrogenic problems associated with parenteral therapy (e.g., phlebitis) would be avoided, the quantities of expensive parenteral drugs purchased might be reduced, and the duration of hospitalization for selected diseases such as osteomyelitis would probably decrease. Finally, the ease of oral administration may allow longer courses of therapy for resistant infections than have heretofore been possible. Oral ciprofloxacin and similar compounds present both opportunities and challenges for pharmacists. The fiscal impact may be beneficial for the hospital in terms of cost reductions for drug purchases and in expediting discharge for prolonged courses of outpatient therapy. The magnitude of cost reductions will vary substantially depending upon the types of patients and infections managed in a given institution. The challenge for pharmacists is to assure that these valuable compounds, as well as all antimicrobial agents, are appropriately utilized to avoid the offsetting costs of adverse effects, superinfection, unnecessary use, and the development of resistance.