Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital.

Controlling antimicrobial costs has preoccupied infectious diseases physicians (IDPs). IDPs have controlled antimicrobial costs by the use of eight strategies: education, formulary restriction, pharmacy justification, formulary substitution, computer surveillance, laboratory item cost listing, purchase plans, and multidisciplinary approaches. Most strategies had input from IDPs and resulted in cost savings (up to $500,000 annually), particularly during the initiation periods. Educational efforts were successful in reducing costs but needed continual intervention. Formulary restriction was the most straightforward cost-control mechanism. Restriction of "target antimicrobials" has given way to "switch" therapy between expensive and less costly agents or between parenteral and oral regimens. Switch therapy is facilitated through the use of innovative order forms and on-line computer interaction. Computer surveillance has a capacity for interactive controls. Purchase plans may give way to centralized pharmacy monitoring, a strategy that is attractive to managed care organizations. Multidisciplinary antimicrobial management programs (AMPs) offer the best potential for sustaining savings in antimicrobial costs. Ten recommendations lay a groundwork for IDPs to translate their expertise into leadership of AMPs.