Practical strategies for the appropriate use of antimicrobials.

The use and misuse of antimicrobial agents is well documented in the literature. A variety of mechanisms has been used to enhance the appropriate use of these agents. A widely used initial strategy is the formation of multidisciplinary groups, such as Pharmacy and Therapeutics Committees or antimicrobial subcommittees, which are responsible for all antimicrobial policies for the health-care facility. Other techniques include the use of antimicrobial order sheets, automatic stop orders, therapeutic substitution, antibiotic restriction systems, and the use of selective antimicrobial susceptibility reporting systems. Many of these strategies have been reported to be effective in the management of antimicrobial usage; however, they also result in increased administrative and monitoring costs. Antimicrobial control systems must be individualized to the health-care facility.