Economic impact of streamlining antibiotic administration.

Decisions concerning antibiotic administration in the treatment of serious hospital-associated infections present important cost considerations and opportunities for the prescribing physician. There tend to be three distinct stages of therapy for such infections and, especially in the latter two stages, cost containment is enabled by close monitoring of mode, level, and frequency of antibiotic dosing. The first stage of therapy typically lasts about three days, during which time uncertainty exists about what is the cause of the infection. Therapy is given empirically, often with the combination of an aminoglycoside and a beta-lactam antibiotic. The second stage begins about the fourth day, at which time definitive microbiologic and clinical data are available that should allow for streamlining of antibiotic therapy, usually from combination therapy to more cost-effective monotherapy. Unfortunately, even when new data indicate that single, inexpensive therapy is possible, physicians often continue with the initial, expensive empiric drugs. It is at this stage in the patient's hospital stay that routine assessment of antibiotic management would offer the first chance to reduce hospital antibiotic costs without compromising clinical outcome. The third stage of therapy typically begins around the seventh day, when the patient is usually clinically stable and afebrile. At this point, often the only reason for continued hospitalization is so that treatment with parenteral antibiotics may continue. In many of these patients, however, therapy can be switched from the parenteral to the oral drug mode, and thus they can be treated on an outpatient basis. Streamlining antibiotic therapy by changing modes and frequency of administration represents a major step toward effective, responsible cost containment.