Hospitals that have tried to cut expenses by limiting the antibiotics they use have actually increased costs and cured fewer patients, a university researcher says.
"For the past 15 to 20 years, hospitals have been creating an advantage for the bacteria in the name of cost control," said Jerome Schentag, professor of pharmaceutics at the State University at Buffalo and director of the clinical pharmacokinetics laboratory at Millard Fillmore Health System in Buffalo, N.Y.
The results of several studies conducted by Schentag and his SUNY Buffalo colleagues argue against the use of a preferred list of drugs called a formulary, which is a common practice among hospitals and HMOs.
Hospitals can save money by restricting the drugs it will allow doctors to prescribe because the handful of antibiotics that make up the formulary can be purchased in bulk.
Each patient is then generally prescribed one type of antibiotic, the logic being that if the drug works it shouldn't be changed, Schentag said.
"The problem is the more you restrict the numbers of antibiotics you attack bacteria with, the easier it is for them to get resistant" and survive the onslaught, he said.
The end result is tougher bugs that are harder and more expensive to kill, he said (See related story, p. 94).
Schentag has developed an alternative treatment plan called cycling, which uses several types of antibiotics to fight diseases.
Hitting a germ with multiple drugs decreases its chance for survival, he said. A bacteria strain may be able to fight off one drug but usually not two different types of antibiotics, he said.
In one study, about 50 patients suffering from infections such as pneumonia took one antibiotic throughout their treatment. Another 50 received one antibiotic for the first three days, then switched to a different type of drug after that.
Among patients who switched drugs there was a 10% higher cure rate, less resistance and a lowering of the cost because the second drug, ciprofloxacin, was taken orally rather than being injected into the patient.
"All the positive outcomes you could look for happened in this study," Schentag said.
Schentag presented his findings last month at a meeting of the American Society for Microbiology in New Orleans, where a few groups exploring the idea of cycling presented their research.
"Cycling is pretty much a new idea. Among those hearing it for the first time, it is very controversial," said Eugene Sanders, M.D., a professor of medicine at Creighton University in Omaha, Neb. He organized the panel on which Schentag spoke in New Orleans.
Some researchers criticized Schentag's system, saying it was still unproved and must be adhered to strictly, so it could be difficult to implement in a big hospital where many people care for each patient, Sanders said.
But Schentag noted the plan has been implemented at Millard Fillmore, a 600-bed hospital. He estimated it has saved the hospital $1,500 annually per bed.
