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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
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
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
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
C. Caveats
1.0 Applicability of this guideline will depend on local antimicrobial resistance patterns and drug
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
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.