To the Editor.
—Drug utilization review assures cost-effective use of medications in hospitals. We present an example of drug utilization review that began with the identification of an "index case" of a costly therapeutic decision. Subsequent investigation lead to the identification of a prescribing outbreak as well as its probable source.
Report of a Case.
—A 32-year-old man had been on a camping trip and noted an insect bite at the top margin of his sock. The next day he noted redness and swelling at the site of the bite. The third day he was febrile and the redness began to spread. On the fourth day, red streaks extended 15 cm above the site of injury. He felt ill and came to the emergency department. His examination demonstrated a temperature of 39.4°C, sickly appearance, and a tender cellulitis of his lower leg. Blood pressure was normal and he did not
Shorr RI, Greene WL. A Food-Borne Outbreak of Expensive Antibiotic Use in a Community Teaching Hospital. JAMA. 1995;273(24):1908. doi:10.1001/jama.1995.03520480026032