Controlling the costs of antibiotic resistance.

Excessive and inappropriate use of antibiotics in hospitals contributes to the development of antibiotic resistance and to increased hospital costs. Denver's three major teaching hospitals have developed a multifaceted approach that has curbed inappropriate antibiotic prescribing and reduced costs for antibiotic purchases. A joint antibiotic-use committee with representatives from each hospital's pharmacy and therapeutics committee developed a single antibiotic formulary for systemically active antibacterial agents, based on simplicity, clinical efficacy, previous use patterns, local resistance patterns, and relative cost. This formulary includes primary agents, ordered at the prescriber's discretion; secondary agents, ordered only for an approved condition; and restricted agents, which had been used excessively or inappropriately in the past, and are now dispensed only after consultation with infectious disease specialists. A computerized antibiotic order-entry program at the Denver V.A. Medical Center requires all physicians to enter antibiotic requests through a centralized computer system. Drug utilization is evaluated using data collected from the computer data base and in vitro data from the microbiology laboratory. In addition, appropriate antibiotic prescribing and infection control practices are taught in an education program for physicians, nurses, and other health care workers.