Evaluation of antibiotic usage: a comprehensive look at alternative approaches

Current problems related to the use of antibiotics in the United States are summarized. In 1979, pharmaceutical manufacturers shipped +1.55 billion worth of anti-infective drugs. It is estimated that in approximately one-half of all cases that involve administration of antibiotics in the hospital, either the medical condition does not require antibiotic treatment, the most effective and least expensive drug is not chosen, or the correct dosage or duration of therapy is not prescribed. Much of the high cost of antibiotic therapy can be attributed to the use of expensive antibiotics of the cephalosporin and aminoglycoside groups and to the excessive duration of antibiotic prophylaxis in surgery. This review presents methods that assess the magnitude of the problem by audit and analyzes the corrective approaches that have been suggested. The major issues of concern related to the use of antibiotics are the complex series of considerations that lead physicians to prescribe antibiotics and the problem of patient expectation and compliance. Excessive usage of antibiotics must be viewed as part of the problem of overusage of all drugs and laboratory procedures.