Experience with a drug formulary in a large Italian city hospital

The preparation and distribution of a drug formulary, providing some 377 pharmacological entities together with significant general information, in a large city hospital, enabled the collection of data on the pattern of drug use in this setting. Out of the 377 selected drugs, 27 were never used in the course of one year: most notable among these were the cephalosporin cephalothin, the antifungal griseofulvin, piperazine and the leading anti-H1-blocker terfenadine. Thirteen pharmaceutical preparations were used in over 50,000 doses; among these were the amiloride + hydrochlorothiazide combination, co-trimoxazole and lorazepam. Examination of specific drug series, e.g. of cephalosporins, showed a clear preference for the longer acting ceftriaxone versus a minor use for oral agents, e.g. cefadroxil. There was a wide choice of cardiovascular agents and a relative stability in the preference for major and minor antipsychotics. Outside of the formulary list, only a small number of preparations were requested, among these some traditional analgesic combinations and some extractive products. The provision of a hospital formulary may, in some way, modify drug choice in the hospital, although some established patterns of use are difficult to change. On the other hand, some interesting information was provided on the criteria of choice of hospital physicians.