Costs of Antibiotic Therapy: Maximizing Effectiveness While Minimizing Cost

The key to efficient antibiotic utilization involves maximization of efficacy and minimization of adverse effects. In addition to antibiotic-acquisition costs and the cost of labor involved in the delivery and preparation of antibiotics, one must consider other less tangible costs. Such costs include patient quality of life, mortality or morbidity associated with extended hospitalization, management of antibiotic toxicity and management of co-administered medications. However, if clinically similar efficacy can be achieved without toxicity, one should select the regimen whose acquisition costs are comparatively low, or which requires less labor, supplies, and time. Although the clinical management of patients is ‘art’ rather than ‘pure science’, this ‘clinical management art’ should be performed on the basis of a thorough understanding and consideration of many aspects of science: Microbiology, pharmacokinetics, pharmacodynamics, and pharmacoeconomics. This chapter will briefly review the basic principles of the ‘microbio-pharmacotherapy’ (such as microbiology, pharmacokinetics and pharmacodynamics) to help understand and practice antibiotic management. Furthermore, this chapter will provide methods to manage antibiotics economically with some examples which have been implemented at our hospital (Hartford Hospital, USA) or have been published from other institutions.