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Appendix K UWHC Guidelines for Cost-Effective Antimicrobial Selection Guidelines developed by UWHC Center for Drug Policy (CDP) Authors: Lizbeth Hansen, Doctor of Pharmacy Candidate; Sarah Bland, RPh Coordination: Lee Vermeulen, MS, Director, CDP Reviewed by: Antimicrobial Use Subcommittee A. Background Between the years of 2000 and 2001 the national spending on retail prescription drugs increased 17.1% (by $22.5 billion). The shift in use from generic drugs to more expensive branded products accounted for 24% of this increase. In addition, broad-spectrum antibiotics were a major 1 contributor to this increase, growing 8.8% ($686 million) during this period. Large, well-designed studies have demonstrated that older, generic medications are as safe and effective as their branded counterparts and can be as safe and effective as new and significantly more expensive products.2 We have compiled from the UWHC Antimicrobial Use Guidelines (AMUG) various low cost options for treating common infections. Other therapeutic alternatives may exist and can be found in the main section of the AMUG. In certain circumstances, more expensive alternatives may be preferred over lower cost agents, and these alternatives are listed in the comments section 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 $15. 2.0 In certain situations an inexpensive or generic drug is not an appropriate therapeutic choice and this is noted with a dollar sign ($), to indicate that the recommended drug exceeds this expense. 2.1 In these situations, the in-house patient assistance program should be contacted (if program is not available, contact the drug manufacturer). 2.2 If a specific infection needing treatment is not found on this table, contact the pharmacy. C. Caveats 1.0 Applicability of this guideline will depend on local antimicrobial resistance patterns and drug availability. 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 generic medications. 3.0 At the time this guideline was written, generic ciprofloxacin, fluconazole and amoxicillin/clavulanate were still in their first 6 months of availability and remained relatively costly. Following the first 6-month period after the release of these generic products, the prices have decreased substantially. 4.0 The recommendations in this guideline apply only to immunocompetent patients. In many cases, immunocompromised patients may require higher-cost brand-name medications.