Invited Commentary

David L. Dunn, MD, PhD
Arch Surg. 1996;131(9):994. doi:10.1001/archsurg.1996.01430210092020.
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Increasingly, attempts are being made to enhance efficiency and reduce unnecessary expenditures in hospitals to save costs. For many institutions, this is not a matter of increasing profits but of remaining financially solvent, particularly for those that reside in fiercely competitive, capitated or discounted fee-for-service health care markets. One of the major targets for reducing expenditures in the hospital environment is that of limiting the use of antimicrobial agents to appropriate, approved indications, ie, preventing their misuse. This is being accomplished in most hospitals by 2 mechanisms: (1) use of highly routinized clinical pathways (usually an antibiotic order form) in which indications and duration of prophylaxis and/or therapy are defined and (2) restriction of the use of some antimicrobial agents, particularly broad-spectrum, expensive antibacterial agents, such that their use requires approval by a designated individual or group of individuals.

Although the drug restriction process is designed to contain costs, it


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