Impact of an antibiotic restriction policy on hospital expenditures and bacterial susceptibilities: a lesson from a pediatric institution in a developing country

Background. In an era of growing concern about bacterial resistance and hos pital costs, limiting the use of broad spectrum antibiotics is important. Objectives, To evaluate the effects of an antibiotic restriction policy on expenditures, antimicrobial resistance rates and clinical outcomes of hospi talized children. Design. Starting in January, 1997, a prior consultation with an infectious disease specialist for using restricted antibiotics was required in all hos pital areas. A retrospective assessment of study objectives obtained 2 year s before (1995, 1996) and 2 years after (1997, 1998) initiation of the rest riction policy was performed. Setting, The present study was conducted in a 500-bed university hospital serving children nationwide of a developing co untry, Panama. Results. Total expenditures for antimicrobial agents decreased by 50%, from $699 543 (US dollars) during 1995 and 1996 to $347 261 during 1997 and 199 8, Susceptibility rates of many nosocomial isolates (especially staphylococ ci and Gram-negative enteric bacilli) usually improved for restricted antib iotics with >35% reduction in utilization (notably for gentamicin, third ge neration cephalosporins, piperacillin and vancomycin). Major improvements i n bacterial susceptibilities were observed in the nursery, a place harborin g microorganisms exhibiting the higher initial resistance rates of the hosp ital. No differences in days of hospital stay and mortality rates of all pa tients and of children with nosocomial infections were detected during the study pe period, Conclusions. Requirement for prior approval of selected antimicrobial drugs in a pediatric institution decreases hospital expenditures and improves su sceptibilities to antibiotics without compromising patient outcomes or leng th of hospital stays.