Effects of requiring prior authorization for selected antimicrobials

Expenditures, susceptibilities, and clinical outcomes

A. Clinton White, Robert L. Atmar, Joan Wilson, Thomas R. Cate, Charles E. Stager, Stephen B. Greenberg

Research output: Contribution to journalArticle

292 Citations (Scopus)

Abstract

Antimicrobial control programs are widely used to decrease drug expenditures, but effects on antimicrobial resistance and outcomes for patients are unknown. When a requirement for prior authorization for selected parenteral antimicrobial agents was initiated at our urban, county teaching hospital, total parenteral antimicrobial expenditures decreased by 32%. Susceptibilities to all β-lactam and quinolone antibiotics increased, with dramatic increased susceptibilities in isolates recovered in intensive care units, increased susceptibilities in isolates recovered in other inpatient sites, and little change in susceptibilities in isolates recovered in outpatient sites despite no change in infection control practices. For patients with bacteremia due to gram-negative organisms, overall survival did not change with restrictions. No differences occurred in the median time from initial positive blood culture to receipt of an appropriate antibiotic or in the median time from positive blood culture to discharge from the hospital. Thus, requiring preapproval for selected parenteral agents can decrease antimicrobial expenditures and improve susceptibilities to antibiotics without compromising patient outcomes or length of hospital stay.

Original languageEnglish (US)
Pages (from-to)230-241
Number of pages12
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - 1997
Externally publishedYes

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Health Expenditures
Anti-Bacterial Agents
Length of Stay
County Hospitals
Lactams
Quinolones
Infection Control
Bacteremia
Anti-Infective Agents
Teaching Hospitals
Intensive Care Units
Inpatients
Outpatients
Survival
Pharmaceutical Preparations
Blood Culture

ASJC Scopus subject areas

  • Immunology

Cite this

Effects of requiring prior authorization for selected antimicrobials : Expenditures, susceptibilities, and clinical outcomes. / White, A. Clinton; Atmar, Robert L.; Wilson, Joan; Cate, Thomas R.; Stager, Charles E.; Greenberg, Stephen B.

In: Clinical Infectious Diseases, Vol. 25, No. 2, 1997, p. 230-241.

Research output: Contribution to journalArticle

White, A. Clinton ; Atmar, Robert L. ; Wilson, Joan ; Cate, Thomas R. ; Stager, Charles E. ; Greenberg, Stephen B. / Effects of requiring prior authorization for selected antimicrobials : Expenditures, susceptibilities, and clinical outcomes. In: Clinical Infectious Diseases. 1997 ; Vol. 25, No. 2. pp. 230-241.
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