Impact of a hospital-based antimicrobial management program on clinical and economic outcomes

Inappropriate use of antimicrobial agents results in unnecessary exposure t o medication, persistent or progressive infection, emergence of resistance, and increased costs. We implemented a program to control use of restricted agents while improving care. This study compared 2 major mechanisms for im proving use of antimicrobial agents: (1) recommendations made by the Antimi crobial Management Team (AMT), which included a clinical pharmacist backed up by a physician from the Division of Infectious Diseases (ID), and (2) re commendations made by ID fellows. Outcome measures included appropriateness of recommendations, cure rate, number of treatment failures, and cost of c are, which were assessed for 180 patients. The AMT outperformed the ID fell ows in all outcomes examined by the study (including appropriateness [87% v s. 47%;], P<.001], cure rate [64% vs. 42%;], P = .007], and treatment failu res [15% vs. 28%;]), P = .03]), although the differences in economic outcom es between cases managed by the AMT and those managed by the ID fellows wer e not statistically significant. In an academic setting with a restricted f ormulary, the AMT demonstrated better antimicrobial prescribing than ID fel lows.