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Resistance-induced antibiotic substitution


  • David H. Howard

    (Department of Health Policy and Management, Rollins School of Public Health, Emory University, USA)


In many cases, physicians prescribe antibiotics without knowing whether an individual patient is infected with a susceptible or resistant pathogen. As the proportion of resistant organisms in a community increases, physicians substitute away from older-inexpensive drugs to newer, more expensive agents as first line therapy. This paper explores the implications of resistance-induced antibiotic substitution for epidemiological models to predict future resistance levels, efforts to measure the health care costs associated with resistance, and policies to improve physicians' antibiotic prescribing decisions. The extent of resistance-induced substitution in outpatient settings is documented using a data set consisting of observations on initial physician office visits for otitis media in the US controlling for new product introductions and price increases, per prescription antibiotic spending increased by 22% between 1980 and 1996, corresponding to a steep increase in resistance levels over the same period. Copyright © 2004 John Wiley & Sons, Ltd.

Suggested Citation

  • David H. Howard, 2004. "Resistance-induced antibiotic substitution," Health Economics, John Wiley & Sons, Ltd., vol. 13(6), pages 585-595.
  • Handle: RePEc:wly:hlthec:v:13:y:2004:i:6:p:585-595 DOI: 10.1002/hec.856

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    References listed on IDEAS

    1. Joanna Coast & Richard Smith & Anne-Marie Karcher & Paula Wilton & Michael Millar, 2002. "Superbugs II: how should economic evaluation be conducted for interventions which aim to contain antimicrobial resistance?," Health Economics, John Wiley & Sons, Ltd., vol. 11(7), pages 637-647.
    2. Brown, Gardner & Layton, David F., 1996. "Resistance economics: social cost and the evolution of antibiotic resistance," Environment and Development Economics, Cambridge University Press, vol. 1(03), pages 349-355, July.
    3. Laxminarayan, Ramanan & Brown, Gardner M., 2001. "Economics of Antibiotic Resistance: A Theory of Optimal Use," Journal of Environmental Economics and Management, Elsevier, vol. 42(2), pages 183-206, September.
    4. Catherine A. Goodman & Paul G. Coleman & Anne J. Mills, 2001. "Changing the first line drug for malaria treatment-cost-effectiveness analysis with highly uncertain inter-temporal trade-offs," Health Economics, John Wiley & Sons, Ltd., vol. 10(8), pages 731-749.
    5. Elamin H. Elbasha, 2003. "Deadweight loss of bacterial resistance due to overtreatment," Health Economics, John Wiley & Sons, Ltd., vol. 12(2), pages 125-138.
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    Cited by:

    1. Filippini, M. & Masiero, G. & Moschetti, K., 2009. "Regional consumption of antibiotics: A demand system approach," Economic Modelling, Elsevier, vol. 26(6), pages 1389-1397, November.
    2. Thomas Heister & Christian Hagist & Klaus Kaier, 2015. "Resistance Elasticity of Antibiotic Demand in Intensive Care," WHU Working Paper Series - Economics Group 15-01, WHU - Otto Beisheim School of Management.
    3. Amitrajeet Batabyal & Peter Nijkamp, 2005. "Alternate strategies for managing resistance to antibiotics and pesticides," Environmental Economics and Policy Studies, Springer;Society for Environmental Economics and Policy Studies - SEEPS, vol. 7(1), pages 39-51, March.

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