THE USE OF FIRST-LINE AND 2ND-LINE OUTPATIENT ANTIBIOTICS UNDER THE SASKATCHEWAN DRUG PLAN

The Saskatchewan Drug Plan proposed de-listing several second-line ant ibiotics from its formulary for reasons of potential overuse and expen se. This study evaluated the use of second-line antibiotics as initial and secondary courses of therapy depending on the patient's prior use of other antibiotics and other factors. A total of 637 607 courses of therapy dispensed to Plan members for selected antibiotics between Ju ly 1989 and June 1990 were evaluated. Second-line antibiotics were use d in 5.0% of all initial courses of therapy. This use was correlated w ith patient characteristics that may warrant use of second-line antibi otics as initial therapy: age, rural residence, the use of bronchodila tors or inhaled steroids, and the number of prior courses of antibioti c therapy. The potential savings from de-listing second-line antibioti cs from the formulary are limited because of their use in only 5% of a ll initial courses of therapy. Savings would be further reduced by adm inistrative costs and physician time required to process prior authori sation requests, and the costs of treating any additional antibiotic t reatment failures that may result from reduced access.