Building the Formulary Case for Novel AMR Antibiotics

Bringing novel gram-negative agents onto a hospital formulary requires a persuasive case grounded in local epidemiology, outcome data, and practical safeguards, especially when committee members lack infectious diseases expertise. Dr. Tamma asks Dr. Pogue how clinicians can justify costly agents with overlapping spectra to pharmacy and therapeutics (P&T) committees and how institutions should choose among them.

Dr. Pogue notes that the case is far easier today than when these agents first launched, because accumulated evidence across Pseudomonas, carbapenem-resistant Enterobacterales, and now Acinetobacter shows that novel therapies improve outcomes. At the institutional level, he recommends defining the problem pathogens and resistance mechanisms locally, testing banked isolates against the new agents, and selecting those that fill specific niches.

Dr. Tamma raises the scenario of a hospital that rarely encounters CRAB but suddenly needs sulbactam-durlobactam. Dr. Pogue argues that formulary status matters even when an agent is rarely used, because it allows the drug to be built into the electronic medical record with renal dosing, interaction checks, and allergy screening. He adds that institutions can arrange access through health system partners or regional hospitals that keep the agent in stock.

Dr. Shields offers the perspective of a P&T committee member, reminding colleagues that most members do not know the acronyms that dominate these discussions and may question why yet another beta-lactam-beta-lactamase inhibitor is necessary. He compares the process to a campaign, in which clinicians must explain the value of each agent clearly, and adds that strong clinical data, mechanism-directed selection, and converging prices have made the argument easier. Clinicians should arrive at P&T discussions prepared with local data and a clear rationale.

Laboratory readiness and clinician education take center stage in "Microbiology Lab Readiness and Education in AMR Care."