Antimicrobial control programs.

The use of broad spectrum antimicrobials, the emergence of multiresistant organisms, and the hospital drug costs associated with antimicrobials have all driven the need for institutions to develop strategies to control the use of antimicrobials. Formulary restrictions, prior approval mechanisms, treatment guidelines, order forms, stop orders, antimicrobial management teams, computer-assisted decision support tools, antimicrobial rotation, and combinations of these practices have all been evaluated as methods to encourage the appropriate use of these agents. While many programs have been successful in reducing antimicrobial costs without compromising patient care, limited data are available on the impact of these programs on the development of multiresistant organisms, particularly in neonatal intensive care units. The optimal means for controlling the emergence of resistance have yet to be determined, but ongoing surveillance of antimicrobial utilization and susceptibility patterns are necessary to identify opportunities for interventions, maximize patient care, and potentially minimize the development of resistance.