Cost-Effectiveness Analysis of Empirical Versus Culture-Guided Antibiotic Therapy in a Tertiary Care Hospital

Background: Empirical antibiotic therapy is routinely initiated in hospitalized patients with suspected bacterial infections; however, prolonged broad-spectrum use may increase antimicrobial resistance and healthcare costs. Culture-guided therapy, involving modification of antibiotics based on culture and antimicrobial susceptibility testing (AST), may optimize treatment and improve cost-effectiveness. Aim of the study was to compare the clinical outcomes and cost-effectiveness of empirical versus culture-guided antibiotic therapy in a tertiary care hospital. Material and Methods: A prospective observational comparative study was conducted in the Department of Pharmacology in collaboration with clinical departments. A total of 75 adult inpatients receiving systemic antibiotics for suspected bacterial infections were included. Patients were categorized into empirical therapy (n=38) and culture-guided therapy (n=37) groups based on antibiotic modification following culture/AST results. Baseline characteristics, microbiological profile, antibiotic utilization, clinical outcomes, and direct medical costs were analyzed. Continuous variables were compared using the Independent t-test, and categorical variables using the Chi-square/Fisher’s exact test. Cost-effectiveness was assessed by comparing mean costs and clinical cure rates. Results: Baseline characteristics were comparable between groups (p>0.05). The culture-guided group demonstrated a significantly higher de-escalation rate (56.8% vs 15.8%, p