Restricted cephalosporin use in teaching hospitals

The approaches of teaching hospitals toward limiting the number of cephalosporin drug products on formularies were studied in a mail survey. Pharmacy department directors of 128 teaching hospitals with 200 beds or more responded to teh survey. Forty-two of 128 (33%) hospitals had established formal restriction policies (FRPs) for cephalosporins (CS). Cephalexin and cephradine were the predominant formulary oral CS. Few hospitals had established "therapeutic equivalents" policies, yet the majority of hospitals had a single oral CS on the formulary. Cefazolin was the predominant injectable CS on all formularies; cefamandole and cefoxitin were the predominant restricted CS. In hospitals without restriction policies, these newer CS were on the formulary in 55% of the cases; in FRP hospitals, the figure was 15%. The occurrence of a single, formulary, unrestricted CS was much more likely in FRP hospitals (38%) than in hospitals with no restriction policy (NRP) (8%). FRP hospitals tended to have fewer unrestricted formulary CS. Eighty-three percent of FRP hospitals and 41% of NRP hospitals monitored CS use.