Cost-containment of antimicrobial therapy.

In 1983, health care services for Medicare and Medicaid patients become tied to a diagnosis-related group (DRG) classification and reimbursed based on predetermined rates, regardless of the amounts expended. U.S. hospitals that formerly encouraged resource consumption to generate revenue now urge judicious use of drugs, laboratory tests, and radiology in an effort to contain costs while maintaining quality patient care. Antimicrobials account for the largest proportion of all drugs used in hospitals, but their inappropriate use, unfortunately, is widespread, resulting in poor therapy, emergence of resistance, increased adverse effects, and wasted health care dollars. Newer beta-lactam agents offer enhanced in vitro potency and spectra of activity, improved pharmacokinetic characteristics, and a relative lack of adverse effects. However, these drugs are expensive, and excessive use defeats cost-containment programs necessary under DRG reimbursement. To ensure their appropriate use, a variety of methods and some control system is probably necessary in most hospitals. In certain situations early discharge of hospital patients and home antimicrobial therapy may be the most desirable method to conserve hospital resources and provide quality health care.