How should we evaluate new anti-infectives for respiratory tract infections?

In assessing the outcomes of anti-infective therapy, microbiological and clinical efficacy have been the most important factors considered. However, increasing attention is being paid to pharmacoeconomic considerations, which include much more than simply the cost of the drug. Nursing and pharmacy time involved in drug preparation and administration, laboratory costs and time in therapeutic drug monitoring, and hospital costs for in-patient care are all factors to be considered. Therapeutic failure caused by using an inexpensive but ineffective drug can thus be very expensive if it leads to prolonged hospitalization. The effort to curb anti-infective drug costs has led to the following strategies: sequential therapy using equipotent oral formulations of intravenous agents; switch therapy, ie, changing to a different class; and step-down therapy, ie, converting to an oral antimicrobial with less potency. Maximal cost effectiveness is related to rapid and effective therapy.