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CRAIG MARTIN, PHARM.D., is Infectious Diseases Clinical Pharmacy Specialist and Assistant Professor, University of Kentucky Chandler Medical Center (UKCMC), Lexington. IGHOVWERHA OFOTOKUN, M.D., is Assistant Professor of Medicine, Infectious Diseases, Emory University School of Medicine, Atlanta, GA. ROBERT RAPP, PHARM.D., FCCP, is Professor of Pharmacy and Surgery, UKCMC. KERRY EMPEY, PHARM.D., is a Ph.D. degree candidate, University of Kentucky, Lexington. JOHN ARMITSTEAD, M.S., FASHP, is Director of Pharmacy Services and Assistant Dean for Medical Center Pharmacy Services, UKCMC. CLAIRE POMEROY, M.D., is Professor of Infectious Diseases and Executive Associate Dean of Medicine, University of California—Davis School of Medicine, Davis. ARDIS HOVEN, M.D., is Professor of Medicine, Infectious Diseases, UKCMC. MARTIN EVANS, M.D., is Professor of Medicine, Infectious Diseases, UKCMC, and Lexington Veterans Affairs Medical Center, Lexington.

Address correspondence to Dr. Martin at the University of Kentucky Chandler Medical Center, C-117, Lexington, KY 40536 (cmart2{at}email.uky.edu).

Purpose. The results of the first five years of an ongoing antimicrobial control program are reported. Methods. In 1998, a multidisciplinary antimicrobial subcommittee of the pharmacy and therapeutics committee of a university hospital was formed and charged with making formulary interventions in an effort to reduce rising antimicrobial resistance rates and drug expenditures. In 1999, a number of measures were implemented for controlling antimicrobial use. Selected antimicrobials with the potential for inappropriate use or whose inappropriate use had been documented were placed in the control of physicians in the infectious diseases (ID) division. Prior approval by an ID physician was required before the pharmacy could dispense these agents. Other key interventions included removal of ceftazidime and cefotaxime from the formulary, restriction of vancomycin and carbapenem use, and replacement of ciprofloxacin with levofloxacin as the sole fluoroquinolone on the formulary. Data regarding antimicrobial use and expenditures between 1998 and 2002 were compared and analyzed. Results. Antimicrobial use was reduced by 80% for third-generation cephalosporins and 15% for vancomycin following the implementation of the new antimicrobial policies. Antimicrobial-resistance patterns for many important gram-negative pathogens, including Pseudomonas aeruginosa, demonstrated a reversal of previous increases. In addition, the rate of methicillin-resistant Staphylococcus aureus decreased by an average of 3% each year from 1999 to 2002. Pharmacy expenditures for all antimicrobials, including antiviral, antifungal, and antibacterial agents, decreased 24.7%, with a cumulative cost saving of $1,401,126, without inflation assumptions. Conclusion. The implementation of an antimicrobial control program decreased the use of selected antimicrobial agents and resulted in substantial reduction of expenditures for antimicrobials. Index terms: Antibiotics; Antifungals; Anti-infective agents; Antivirals; Carbapenems; Cefotaxime; Ceftazidime; Cephalosporins; Ciprofloxacin; Costs; Drug use; Economics; Formularies; Hospitals; Levofloxacin; Pharmacy and therapeutics committee; Prescribing; Protocols; Pseudomonas aeruginosa; Quinolones; Rational therapy; Resistance; Staphylococcus aureus; Vancomycin

 

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