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A cross-sectional study was conducted to investigate the influence of the co-payment policy in a community setting on the purchase of prescription medications for children with acute infections. Data for all purchased medications prescribed for children with an acute infectious disease were gathered from a pediatric health care center over a 6-week period. Parents of the sick children and controls were interviewed by telephone, using a short sociodemographic questionnaire, and were asked to state their reasons for not purchasing (either partially or completely) necessary medications, primarily antibiotics. Of the 779 children who received a prescription for antibiotics during the 6-week period, 162 (20.7%) failed to take the complete course of antibiotic treatment. One hundred and one parents of these children (62.3%) were interviewed, of whom 30 (29.7%) claimed that the main reason for not buying the full course of antibiotic medication was the cost. This group is characterized by low income, overcrowded housing conditions and a large quantity of prescription medications. The cost of prescribed medication under the co-payment policy is a serious barrier to the purchase of prescribed medication for children with acute infections in the primary care setting. The policy has a particularly deleterious effect in under-privileged populations and is in contradiction with the proclaimed principles of justice and equality underlying the obligatory Israeli National Israeli Health Insurance Law and similar laws in other western countries.

To prospectively evaluate patient (parent), physician, and nurse satisfaction with antibiotics, 12,102 children in 661 pediatric study centers throughout the United States with infections to be treated on an outpatient basis were followed with questionnaires completed by parents and with interviews of patients and their parents. Comprehensive surveys were also completed by participating pediatricians and their nursing staffs of which 11,913 (98.4%) contained adequate information for inclusion in an analysis. Data were combined and analyzed using standard statistical methods. Loracarbef was perceived as being superior to other antibiotics based on cost, palatability, and dosing intervals. Few differences were seen among most antibiotics based on treatment outcome or adverse events. All antibiotics studied offered acceptable efficacy and were well tolerated as judged by physicians, nurses, parents, and children. Slight differences might result in increased compliance for some patients.

The object of this study was to improve the use of antibiotics at Aker University Hospital, a 600-bed university hospital. We developed and implemented guidelines for antibiotic treatment and prophylaxis. We describe the impact of these guidelines on the use and cost of antibiotics and evaluate compliance with the guidelines. From 1994 to 1996 there was an 11% reduction in the use of antibacterial agents and a 42% reduction in the use of antifungal agents. The use of broad-spectrum antibiotics was reduced by 23%. The use of penicillin V and G increased by 5%, dikloxacillin/kloxacillin by 46% and erythromycin by 33%. Compared with 1994 values there was a 27% reduction in antibiotic costs in 1995, amounting to US$ 319,300, and a 32% reduction in antibiotic costs in 1996, amounting to US$ 380,000. A point-prevalence investigation conducted 18 months after the introduction of the guidelines indicated that compliance was > 95%. It proved possible to reduce the use of broad-spectrum antibacterial and antifungal agents, with significant cost savings. Point-prevalence studies may be a useful tool to detect deviations from guidelines and provide physicians with educational feedback.

There has been growing interest in recent years in early switch therapy: antibiotics are administered intravenously during the early phase of the infection, and then continued orally. A large number of recent prospective and randomized studies justify the application of an early switch. There is consensus in the literature about the circumstances in which an early switch is justified: (a) the patient must show clinical improvement; (b) the oral therapy should result in sufficiently high levels at the infection site; (c) the patient must be capable of taking oral medication, there must be no signs of malabsorption and interactions with food or with other drugs should be taken into account; (d) if these rules are observed, switch to oral therapy as a rule is justified after 2 to 3 days' intravenous administration. An early switch is more comfortable to the patient, eases the load on the nursing staff and considerably reduces expenses.

Objective: to determine the practicality of treatment of infectious conditions requiring prolonged parenteral antimicrobial therapy., Method: review of all patients admitted to a Regional Infectious Diseases (ID) Unit who received outpatient parenteral therapy over a 12-month period. The study identified the conditions suitable for outpatient therapy, the organization of treatment and the complications and financial implications of the service., Results: fifteen patients (age range 32-81) received outpatient parenteral antimicrobial therapy during the period of the study. Five patients were HIV-positive and were treated for cytomegalovirus retinitis or severe recurrent candida infection with self-administration of drugs through a Hickman line. HIV-negative patients were treated for osteomyelitis, deep-seated abscesses and subacute bacterial endocarditis. Eight of the 10 HIV-negative patients were given ceftriaxone once daily. The organization and delivery of outpatient drug therapy depended on the nature of the underlying infection and the availability of community services. Outpatient therapy was associated with considerable financial savings, and no serious adverse events were recorded., Conclusion: outpatient parenteral treatment is a reasonable option for a relatively small number of patients, representing less than 2% of patients admitted to the ID Unit over the time course of the study. Patients suitable for outpatient treatment have a stable medical condition and require prolonged antimicrobial therapy.

Home intravenous antibiotic therapy (HIVAT) has proven to be a safe, effective, and cost-saving method to treat appropriately selected patients with bone, soft tissue, respiratory, genitourinary, and cardiac infections. Further, the acceptance of HIVAT by both physicians and patients has been enhanced by the availability of new venous access devices and home IV therapy companies. In determining when to use HIVAT, it is important to carefully consider the individual patient, the disease or medical condition, and antibiotic selection. HIVAT requires a team approach, with the physician, pharmacist, IV therapy nurse, and others playing critical roles in successful treatment plans.

Prescribing antibiotics for perioperative prophylaxis in common surgical procedures presents an ideal target for educational intervention. In this situation, antibiotics are often used inappropriately, with consequent excess expense and risk of morbidity. We developed an educational intervention aimed at the choice and appropriate dosing of antibiotics for the prophylaxis of cesarean sections. Person-to-person educational messages targeted at authoritative senior department members were supplemented by brief reminders on a structured antibiotic order form. Time-series analyses were conducted on 34 months of antibiotic use data for 2,783 cesarean sections to estimate the trend of magnitude and significance of discontinuities associated with the start of the program. Prior to the intervention, 95% of sections receiving prophylaxis were given cefoxitin and 3% were given cefazolin. After the intervention, these proportions were reversed, with the shift in use occurring immediately after the intervention (p less than .001). Two years after the intervention, virtually all patients undergoing cesarean sections who receive antibiotic prophylaxis are given cefazolin. Savings from this change alone accounted for over $26,000 each year, or $47.36 per patient-day of prophylaxis. Substantial changes in prescribing practices for routine procedures can be accomplished through the implementation of a coordinated educational program that enlists influential senior staff members in a department in which policy-making is highly centralized, coupled with a structured educational ordering system. Lasting improvements in clinical practices may be brought about by means that are noncoercive, inexpensive and well-accepted by medical staff.

Antimicrobial agents account for a significant proportion of drug expenditures and are used inappropriately approximately half the time in hospital practice. This has led to substantial increases in medical costs for hospitalized patients. Methods have been proposed to reduce inappropriate use of antibiotics, particularly in hospitalized patients. Two of these methods, education and control, were employed effectively by infectious disease specialists at a university teaching hospital to reduce inappropriate use of second-generation cephalosporins. These efforts resulted in significant savings of approximately $130,00 per year. The infectious disease specialist may also make major contributions to cost containment of antibiotics in other equally important areas, including other classes of antibiotics, inappropriate daily frequency, excessive duration of administration, and prevention of adverse drug reactions. The infectious disease specialist is better trained in appropriate antimicrobial use and clinically more knowledgeable in treating infections than other medical specialists and is the best-equipped member of the medical staff to educate the medical community on antibiotic use and to control antibiotic costs.