Implementation influence of antibiotic prescribing guidelines on their usage and costs of therapy

Abstract

Introduction/Aim: Pharmacoeconomics is a scientific discipline which aims to harmonize and find the best possible medicament which can provide optimal effects at minimum price for treatment. The survey is conducted in three phases, and included all patients hospitalized in eight Clinics of Clinical Center of Vojvodina (Serbia) which are the largest consumers of antibiotics. Methods: The first phase involved retrospective evaluation of the entire former antibiotics consumption in three months treatment of bacterial infections. The total cost of consumed antibiotics was calculated as well as daily doses were defined per 100 patient day cost for each clinic separately. In the second phase, the structure of bacterial causes and their resistance to standard antimicrobial therapy were established for all isolated strains from research material collected at each clinic. Guidelines for initial adequate antimicrobial therapy were made (regarding localization and type of bacteria) based on the results of monitoring resistance in bacteria and considering resistance maps for isolated bacterial strains. The guidelines took into consideration antibiotic drug selection: pharmacotherapeutic/pharmacoeconomic principles, bacterial resistance, patterns of antimicrobial prescriptions and minimum cost of therapy. In the third phase (of the three-month period) the guidelines were implemented in therapy of bacterial infections. The aim of the study was to make guidelines for an adequate antimicrobial therapy based on the surveillance of resistance to antibiotics. Our aim was to estimate the effect of guidelines on antibiotic consumption and costs of therapy. Results: During period of guidelines implementation for initial adequate antimicrobial therapy, savings of 20270,19 euros (18, 8%) were noted at four clinics, in comparison to previous period when guidelines were not applied. At the Infectious Diseases Clinic savings in treatment costs were 33.9%, at the Endocrinology Clinic 34.6%, at the Hematology Clinic 8.2% and at the Gastroenterology Clinic 2.8%. Conclusion: Monitoring of bacterial resistance and pharmacoeconomic studies should become an integral part of health care system in Serbia.