EFFECTS OF REQUIRING PRIOR AUTHORIZATION FOR SELECTED ANTIMICROBIALS - EXPENDITURES, SUSCEPTIBILITIES, AND CLINICAL OUTCOMES

Antimicrobial control programs are widely used to decrease drug expend itures, but effects on antimicrobial resistance and outcomes for patie nts are unknown, When a requirement for prior authorization for select ed parenteral antimicrobial agents was initiated at our urban, county teaching hospital, total parenteral antimicrobial expenditures decreas ed by 32%. Susceptibilities to all beta-lactam and quinolone antibioti cs increased, with dramatic increased susceptibilities in isolates rec overed in intensive care units, increased susceptibilities in isolates recovered in other inpatient sites, and little change in susceptibili ties in isolates recovered in outpatient sites despite no change in in fection control practices, For patients with bacteremia due to gram-ne gative organisms, overall survival did not change with restrictions. N o differences occurred in the median time from initial positive blood culture to receipt of an appropriate antibiotic or in the median time from positive blood culture to discharge from the hospital, Thus, requ iring preapproval for selected parenteral agents can decrease antimicr obial expenditures and improve susceptibilities to antibiotics without compromising patient outcomes or length of hospital stay.