Antibiotic restriction in hospitals associated with medical schools

Restriction of antibiotic use in 112 hospitals that are primary teaching facilities for medical schools was studied by mail questionnaire to pharmacy directors and infectious disease physicians. Questions involved whether use of certain antipseudomonal penicillins, aminoglycosides, and second- and third-generation cephalosporins was restricted, reasons for restrictions, existence of a formal education program on new antibiotics, whether the physician respondents agreed with the practice of antibiotic restriction, what percent of requests for use of restricted agents was denied, formulary status of the drugs, the procedure for authorizing dispensing of restricted agents, and the percent of drug expenditures represented by restricted agents. Direct control (specialist authorization or restricted indications for use) was used in 62 (57%) of 108 institutions responding. Nonformulary status indirectly controlled use in 35 institutions. No significant differences in the prevalence of restrictions were found for hospital size, ownership, physician's view of the restrictions, or presence of an education program. Most (85%) of the physicians agreed with restriction practices. Cost was the reason given most frequently for restriction of the penicillins and cephalosporins, while aminoglycosides were most frequently restricted because of bacterial resistance. The specialist's oral authorization was the most common method of approval for use of restricted agents. Expenditures for restricted drugs varied widely, suggesting that different levels of control were considered "restriction" by the responding institutions. Control of antibiotic use is common in these teaching hospitals associated with medical schools. No best method for antibiotic restriction was evident.