To the Editor.—I read with great interest the two reports on antibiotic utilization in the September 1988 issue of the Archives.1,2 In this connection, I wish to draw the authors' attention to our experience, published previously.3 Our protocol resembled that of Briceland et al,2 taking the form of recommendations rather than controls. Our results were slightly less impressive in terms of acceptance (69% of recommendations followed), but more so in terms of cost savings ($408 per bed per year [1983]). Perhaps both differences reflect the more extreme nature of some of our recommendations, eg, stopping antibiotic treatment altogether.
Perhaps there is no way that is best for all hospitals, but our impression was that physicians respond positively to recommendations that they are free to accept or reject; often, in fact, they deeply appreciate the education thus given at no cost to their ultimate autonomy. It was