Enforcing a policy for restricting antimicrobial drug use

$82,544 reduction in restricted antimicrobials after 2 months, but $79,008 increase in cost of unrestricted. After aztreonam restricted, acquisition costs decreased from $53,496 per month to $10,115 per month after two months. Hospital reduced costs by $300,235 over nine-month period.

Reference:
Maswoswe JJ, Okpara AU. Enforcing a policy for restrcting antimicrobial drug use. American Journal of Healthy Systems Pharm. 1995 (52): 1433-1435.

Setting:
580-bed, county teaching hospital, Houston, TX, USA

Key staff:
infectious disease physicians, pharmacists

Intervention:
Restriction – Eight IV antibiotics (amikacin, aztreonam, ceftazidime, ciprofloxacin, fluconazole, imipenem-cilastatin, ofloxacin, and ticarcillin-clavulanate, (aztreonam was added to list two months into intervention) previously needed approval, but enforcement of restrictions lax. All staff informed that ID approval needed for dispensement and that pharmacists needed to be informed in writing or by telephone. Enhanced enforcement included issuing warnings to pharmacists if restricted antibiotics dispensed without ID approval.

Impact:
$82,544 reduction in restricted antimicrobials after 2 months, but $79,008 increase in cost of unrestricted.  After aztreonam restricted, acquisition costs decreased from $53,496 per month to $10,115 per month after two months.  Hospital reduced costs by $300,235 over nine-month period.