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September 1988

Antibiotic Streamlining From Combination Therapy to Monotherapy Utilizing an Interdisciplinary Approach

Author Affiliations

From the Department of Pharmacy Services (Drs Briceland and Nightingale and Ms Smith) and the Division of Infectious Diseases (Drs Quintiliani and Cooper), Hartford (Conn) Hospital, and the Department of Medicine, University of Connecticut School of Medicine, Farmington (Dr Quintiliani). Dr Briceland is now with the Albany (NY) College of Pharmacy.

Arch Intern Med. 1988;148(9):2019-2022. doi:10.1001/archinte.1988.00380090091022

• Streamlining of antibiotic therapy from a more complex to a less complex regimen should reduce hospital costs. Utilizing the expertise of an infectious disease physician and clinical pharmacists, an antibiotic-streamlining program was implemented by (1) daily collection of data on patients receiving two or more parenteral antibiotics, (2) formulation of recommendations of cost-effective alternative therapy when clinically appropriate, (3) oral and/or written communication of the reasons for the recommendation to the patient's physician, (4) follow-up monitoring, and (5) determination of the cost savings by subtracting the actual cost of antibiotic therapy (including labor and supplies) from the cost of the initial regimen if it had been continued without alteration. Streamlining recommendations were made in 340 of 625 patients who were reviewed during the initial seven months. Cases that necessitated streamlining recommendations decreased from 98.6% during the first month to 54.4% during the seventh month, reflecting the educational impact of the program on prescribing habits. Recommendations were followed in 82.6% of the cases, of which 97.2% completed therapy with the streamlined regimen. The projected annual savings of the program was $107637.

(Arch Intern Med 1988;148:2019-2022)