[Modifiability of antibiotic use in a medical clinic]

The most costly drug interventions in hospitals are in the treatment of infectious diseases. To improve the cost-effective use of antibiotic drugs it is necessary to consider rational indications, appropriate administration (sequential therapy) and control of antimicrobial resistance. To obtain more information about prescribing habits, antibiotic prescription forms were collected prospectively over a six-month period in the Clinic of Internal Medicine at the Cantonal Hospital of Aarau. The influence of this new prescription form on antibiotic use, including the indication for therapy, was analyzed and compared with the results of a similar study done in 1994. The results showed use of a wide variety of different antibiotics for the same indication, prevalence of intravenous administration, and widespread use of new and expensive antibiotics. The total cost of antibiotics was not reduced compared with the previous period. The characteristics of antibiotic use were easily analyzed with minimal additional effort. With such data, specific actions for quality improvement in antibiotic use can be taken through a multidisciplinary educational approach with regular instruction on therapy guidelines, definition of first-line agents, information on the advantages of sequential therapy, and periodic reevaluation.