Antimicrobial agents rationale and monitoring in an Italian hospital

Optimizing the use of antimicrobial agents may impact considerably on the total pharmaceutical costs sustained by any given hospital. At the San Bortolo Hospital in Vicenza, Italy, antimicrobial usage was monitored over an 18-month period and a cost analysis was performed. In 1993 the cost for antimicrobial agents was 20.3% of the total pharmaceutical costs of the hospital budget. Third-generation cephalosporins were the most frequently used class of drugs. In order to rationalize costs, actions put into place in the first few months of 1993 included, among others, an update of the hospital formulary and adoption of a request procedure for obtaining antimicrobial agents outside the formulary. There was a trend towards a reduction in the cost of antimicrobial therapy (6 to 7% savings for the acquisition of antimicrobial agents) in the first semester of 1994 compared with the same time period in 1993. This cost reduction was accomplished mainly by an increase in the use of some less expensive agents, in particular first- and second-generation cephalosporins, but also by a decrease in the use of teicoplanin, imipenem-cilastatin, ceftazidime and ureidopenicillins.