To the Editor: The medical community should
be aware of a pharmaceutical marketing practice that creates pressure on hospital
pharmacies to distort incentives and recommendations regarding antimicrobial
use from those arising exclusively from efficacy, toxicity, and single drug
cost-effectiveness considerations. There are important counterforces to these
pressures—medical education, practice standards, the hospital's pharmacy
and therapeutics committee, clinician integrity—but loss of prescriber
confidence in pharmacy recommendations can have damaging consequences. Among
these is undermining programs to decrease overall antimicrobial use designed
to delay the spread of antimicrobial resistance.