A multidisciplinary cost-containment program for promoting oral
metronidazole in place of oral
vancomycin as initial
therapy of
antibiotic-associated colitis (AAC) is described. The pharmacy department and the division of
infectious diseases implemented the program in two phases. In the first phase, a one-year retrospective drug-use review in patients with AAC treated with oral
vancomycin was conducted to determine the average cost of
therapy per treatment course. In the second phase, the use of oral
metronidazole instead of oral
vancomycin for initial treatment of AAC was promoted using inservice-education programs and distribution of pocket-size brochures containing AAC treatment guidelines to medical staff. The pharmacy and therapeutics committee supported the program by endorsing
metronidazole as the
drug of choice for AAC and by distributing follow-up progress reports of the program to medical staff. Pharmacists on the nursing units were responsible for enforcing the program stipulations regarding
vancomycin and
metronidazole use and for collecting data on patient-specific
drug use. Six months after implementation of the program, the average cost of
drug therapy for AAC had decreased by 89%, from $343.24 per patient to $37.50 per patient. The projected annual savings resulting from the program was $38,829.02. All prescribing physicians and dispensing pharmacists complied 100% with the program stipulations regarding
drug use. The multidisciplinary program described here was successful in promoting the use of oral
metronidazole for initial
therapy of AAC.