Influencing Drug Choice
Recent interest has focused on improving antimicrobial-drug use by controlling the choice of antimicrobial agents by individual prescribers. Some reported efforts attempt to limit use of inappropriate agents by removing specific drugs from the list of available agents in the formulary or restricting them to certain specialists (51,52). Practice guidelines are a means of achieving uniformity of antimicrobial-drug use that have been applied to many areas in addition to that of infectious diseases. Project ICARE (Intensive Care Antimicrobial Drug Resistance Epidemiology) is a cooperative project of the National Nosocomial Infections System of the Centers for Disease Control and Prevention and the Rollins School of Public Health of Emory University. A 1998 survey of 47 hospitals participating in Project ICARE showed that clinical practice guidelines were reported frequently (70% of hospitals) among measures to improve prescribing practices (53). Guidelines are particularly useful in reducing costs of therapy and total costs of prescription, while maintaining quality of care (54). The question is whether these efforts can reduce prevalence of antimicrobial-drug resistance; major successes have been noted in recent studies, both in the community and hospital