Impact of antimicrobial control programs on patient outcomes - Pharmacy perspective

Antimicrobial control programs are now commonplace in institutional settings, with pharmacists taking a central role in their inception and implementation. These programs often contain a variety of individual systems including formularies, restricted access, clinical pathways, antimicrobial management services, streamlining, intravenous to oral conversions and provider education. Economic concerns and the desire to limit antimicrobial resistance have driven a majority of these programs. Most antimicrobial controls have a potential to improve patient care through appropriate antimicrobial use and avoidance of adverse drug effects. However, there also exists a potential for impairing patient outcomes by dictating antimicrobial selection and use. The impact of these programs on patient clinical outcomes is not well documented. In studies where clinical outcomes were collected, most found no significant differences in resolution of infection, mortality, or the incidence of adverse drug reactions. However, no studies reported a significant negative impact on patient outcomes. Further research is needed to evaluate the clinical impact of antimicrobial control programs. It is imperative to combine clinical outcomes with the economic and resistance outcomes generated. Pharmacists must continue to be involved in antimicrobial control programs and should strive to include patient outcomes in all evaluations.