Antimicrobial use in otolaryngeal infections: general considerations.

With the development of numerous new antimicrobials and the improved efficacy of existing agents, more infections are being treated successfully, but the benefits of one agent over another have become an issue of subtle distinctions. Some clinical studies of new drugs have inherent drawbacks in their design and may not yield a comprehensive picture of antimicrobial characteristics in a wide range of patient types and diseases. Studies should therefore be carefully evaluated to determine whether a real advantage exists for a new agent. At Barnes Hospital (St Louis, Missouri), antimicrobials are chosen for the formulary on the basis of efficacy, toxicity, and cost. One or two agents are selected from a group of "therapeutic equivalents." Nonformulary agents or uses must be approved by the infectious disease staff. Evaluation and discussion of therapy with formulary and nonformulary drugs educates house staff, who can then use approved agents with greater knowledge and skill.