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Effect of formulary restriction of cefotaxime usage
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Formulary restriction did not reduce cefotaxime sodium use or improve its appropriateness. Usage rates increased post-restriction, with consistent appropriate use across medical, pediatric, and surgical services.
Area of Science:
- Pharmacoeconomics
- Infectious Diseases
- Clinical Pharmacy
Background:
- Cefotaxime sodium is a third-generation cephalosporin antibiotic.
- Formulary restriction is a common strategy to control drug costs and optimize use.
- The impact of formulary restriction on cefotaxime usage patterns and appropriateness was evaluated.
Purpose of the Study:
- To assess the effect of formulary restriction on the rate and appropriateness of cefotaxime sodium use.
- To analyze cefotaxime usage across different hospital services before and after restriction.
Main Methods:
- A retrospective review of 187 patient cases over 18 months.
- Comparison of cefotaxime usage and appropriateness before and after formulary restriction.
- Analysis of usage by hospital service and indication.
Main Results:
- Post-restriction usage rates significantly increased in medicine, pediatrics, and surgery services.
- Appropriate use was consistently high (85%) and unaffected by formulary restriction.
- Pneumonia, sepsis, meningitis, and immunosuppression were primary indications for use.
- Gram-negative bacilli were prevalent pathogens.
Conclusions:
- Formulary restriction was ineffective in reducing cefotaxime sodium usage rates.
- Formulary restriction did not impact the appropriateness of cefotaxime sodium use.
- Continued monitoring of antibiotic use is essential, regardless of formulary status.
Abstract:
Cefotaxime sodium was assigned to the open formulary for 12 months and then was placed on formulary restriction to evaluate the restriction's effect on rate of use by services and appropriateness of use. Over 18 months, 187 cases (72 before and 115 after restriction) were reviewed. The majority of use (prerestriction and postrestriction) was in the medicine, pediatrics, and surgery services. The postrestriction usage rate for the three services increased significantly. Cefotaxime was used appropriately in 85% of cases during both periods and was not used prophylactically. Appropriateness of use was independent of formulary restriction. During both periods, approximately 76% of patients received cefotaxime for pneumonia, sepsis, meningitis, or immunosuppression. Of 205 infections, gram-negative bacilli accounted for over half of the pathogens isolated. Thus, formulary restriction was ineffective in reducing the rate of cefotaxime usage and had no effect on the appropriateness of usage.