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Effect of a selective restriction policy on antibiotic expenditure and use: an institutional model
P Suwangool1, P Moola-Or, A Waiwatana
1Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Abstract:
Strictly enforced antibiotic formulary restriction in combination with formulation of agreed guidelines for antibiotic use in common infection problems such as septicemia, febrile neutropenia, urinary tract infection, biliary sepsis, liver abscess, peritonitis, nosocomial pneumonia, soft tissue infection and purulent meningitis, generated a combined savings of 307,748.5 bahts or 13.5 per cent cost reduction over a 6 month period, and improved quality of use, appropriate 54.8 vs 67.5 per cent, statistically significance (P less than 0.002). Although this saving was offset in part by increased spending of unrestricted antibiotics, such as Penicillin and Gentamicin, an overall cost saving remained. In the months during the restrictions, no significant changes occurred regarding patients response and mortality. However, after the onset of the controls, it was revealed that antibiotics were more appropriately used afterwards. This study has shown, most importantly, that savings were achieved with no negative effect on good patient care. Moreover, the antibiotic use control was operationally successful, most house-staff and attending physicians, not only antibiotic evaluating team, have accepted the program in a very positive way. Overall, this program successfully achieved its initial goal, cost saving without compromising good medical practice. We are now continuing our program and also trying to modify so that it will be useful to all departments in the hospital.
Insights
Implementing antibiotic formulary restrictions and usage guidelines significantly reduced costs by 13.5% within six months. This antibiotic stewardship program improved appropriate use without negatively impacting patient outcomes or mortality rates.
Area of Science:
- Pharmacoeconomics
- Infectious Disease Management
- Healthcare Policy
Background:
- Antibiotic resistance necessitates cost-effective and judicious antimicrobial use.
- Hospital antibiotic expenditures require strategic management to optimize resource allocation.
Purpose of the Study:
- To evaluate the economic impact of implementing antibiotic formulary restrictions and usage guidelines.
- To assess the effect of these interventions on the quality of antibiotic prescribing and patient outcomes.
Main Methods:
- A 6-month study period involving strict antibiotic formulary restriction and guideline development for common infections.
- Monitoring of antibiotic expenditure, prescribing appropriateness, patient response, and mortality rates.
Main Results:
- A 13.5% cost reduction (307,748.5 Bahts) was achieved through formulary restrictions and guidelines.
- Appropriate antibiotic use increased significantly from 54.8% to 67.5% (P < 0.002).
- No significant adverse effects on patient response or mortality were observed.
Conclusions:
- Antibiotic stewardship programs, including formulary restrictions and guidelines, can achieve substantial cost savings without compromising patient care quality.
- The program demonstrated operational success and positive acceptance among healthcare professionals.
- The findings support the continued and expanded implementation of antibiotic control measures across hospital departments.