Reduction in antibiotic costs by restricting use of an oral cephalosporin.

Antibiotic cost control programs are important; however, they may be difficult to implement if they include intensive involvement of infectious diseases specialists. In a large municipal hospital, review of antibiotic cost data indicated that 31 percent of the total antibiotic expenditure was for an oral cephalosporin, cephalexin. The requirement that an antibiotic justification form be completed did not decrease use of the drug. However, the requirement that the prescribing physician telephone an infectious diseases specialist resulted in marked restriction of the oral cephalosporin and was accompanied by a 29 percent reduction (adjusted for inflation) in total antibiotic costs. Since comparatively few telephone requests were made and since the decision process to use an oral cephalosporin is comparatively simple, marked reduction in antibiotic costs was achieved with relatively little effort by the infectious disease expert.