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IV. Problems in the Use of Antibiotics |

Problems of Antibiotic Usage: Definitions, Causes, and Proposed Solutions

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Grant support: by the Medical Research Service of the Veterans Administration.

▸Requests for reprints should be addressed to Calvin M. Kunin, M.D.; Medical Service, William S. Middleton Memorial Veterans Administration Hospital, University of Wisconsin; Madison, WI 53705.

Madison, Wisconsin

Ann Intern Med. 1978;89(5_Part_2):802-805. doi:10.7326/0003-4819-89-5-802
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Standardized surveillance methods are needed in order to obtain valid comparisons among institutions concerning use of antimicrobial agents. These include use of data from the hospital pharmacy and review of routine orders for prophylaxis in surgery and for specific infectious diseases. Audits of individual agents should be based on standardized guidelines for use. Attempts to improve the quality of use of antimicrobial agents require understanding of the constraints of medical practice that affect use of drugs to solve problems. These include the practice setting, cost and availability of laboratory support, and patient expectation. Promotion by the pharmaceutical industry capitalizes on the motivation of the physician to help his patient, often in settings in which diagnosis and management are uncertain. Promotion is a continuous process beginning early in medical school and extending to the media and university teaching staffs. The overall solution to inappropriate antibiotic use requires more than educational programs. There should also be a well-structured hospital program regulating pharmaceutical representatives, the formulary, antimicrobial susceptibility tests, justification for high-cost agents, and development of mutually agreed on guidelines for use.







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