Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Appendix KUWHC Guidelines for Cost-Effective Antimicrobial SelectionGuidelines developed by UWHC Center for Drug Policy (CDP)Authors: Lizbeth Hansen, Doctor of Pharmacy Candidate; Sarah Bland, RPhCoordination: Lee Vermeulen, MS, Director, CDPReviewed by: Antimicrobial Use SubcommitteeA. BackgroundBetween the years of 2000 and 2001 the national spending on retail prescription drugs increased17.1% (by $22.5 billion). The shift in use from generic drugs to more expensive branded productsaccounted for 24% of this increase. In addition, broad-spectrum antibiotics were a majorcontributor to this increase, growing 8.8% ($686 million) during this period. 1 Large, well-designedstudies have demonstrated that older, generic medications are as safe and effective as theirbranded counterparts and can be as safe and effective as new and significantly more expensiveproducts. 2We have compiled from the UWHC Antimicrobial Use Guidelines (AMUG) various low costoptions for treating common infections. Other therapeutic alternatives may exist and can befound in the main section of the AMUG. In certain circumstances, more expensive alternativesmay be preferred over lower cost agents, and these alternatives are listed in the commentssection in Table 1 of this appendix.B. Antimicrobial Options (Table 1)1.0 Almost all of the medications in this table should (after adding an appropriate dispensing fee)be accessible to cash-paying patients for under $15.2.0 In certain situations an inexpensive or generic drug is not an appropriate therapeutic choiceand this is noted with a dollar sign ($), to indicate that the recommended drug exceeds thisexpense.C. Caveats2.1 In these situations, the in-house patient assistance program should be contacted (ifprogram is not available, contact the drug manufacturer).2.2 If a specific infection needing treatment is not found on this table, contact thepharmacy.1.0 Applicability of this guideline will depend on local antimicrobial resistance patterns and drugavailability.2.0 Prices are based on Maximum Allowable Cost (MAC) for the Wisconsin Medicaid system.The MAC system is commonly used to establish reimbursement levels for genericmedications.3.0 At the time this guideline was written, generic ciprofloxacin, fluconazole andamoxicillin/clavulanate were still in their first 6 months of availability and remained relativelycostly. Following the first 6-month period after the release of these generic products, theprices have decreased substantially.4.0 The recommendations in this guideline apply only to immunocompetent patients. In manycases, immunocompromised patients may require higher-cost brand-name medications.