Problem of antibiotic usage. Definitions, causes, and proposed solutions.

Standardized surveillance methods are needed in order to obtain valid comparison among institutions concerning use of antimicrobial agents. These include use of data from the hospital pharmacy and review of routine orders for propolyaxis in surgery and for specific infectious diseases. Audits of individual agents should be based on standardized guidelines for use. Attempts to improve the quality of use of antimicrobial agents require understanding of the constraints of medical practice that effect use of drugs to solve problems. These include the practice setting, cost and availability of laboratory support, and patient expectation. Promotion by the pharmaceutical industry capitalizes on the motivation of the physician to help his patient, often in setting in which diagnosis and management are uncertain. Promotion is a continuous process beginning early in medical school and extending to the media and university teaching staffs. The overall solution to inappropriate antibiotic use requires more than educational programs. There should also be a well-structured hospital program regulating pharmaceutical representatives, the formulary, antimicrobial susceptibility tests, justification for high-cost agents, and development of mutually agreed on guidelines for use.