To the Editor.—We have read Avorn and coworkers' article1 with great interest and would like to describe a similar educational program at our institution designed to reduce the costs associated with selected combination antibiotic therapies. Various methods used to compare relative therapeutic options have been reported in the literature.2 Some antibiotics, which appear to be more expensive at first glance, may actually be cost-effective when reviewed in greater detail. A cost comparison of actual vs proposed therapeutic alternatives can provide needed insight in this area.
During an 8-week period, the Infectious Disease Service and the Department of Pharmacy Services, St Elizabeth's Hospital, Tufts University, Boston, Mass, identified 19 patients receiving a course of antibiotic therapy consisting of either imipenem and cilastatin (Primaxin and MSD, respectively) as a sole agent or a multiple antibiotic drug regimen with comparable bacterial coverage. At least two of the following available agents