A perspective of cephalosporins in pneumonia

Reducing costs and hospital stay for pneumonia with home intravenous cefotaxime treatment: results with a computerized ambulatory drug delivery system

Studies have documented the efficacy and safety of antibiotic infusion in the home as a cost-effective alternative to in-hospital infusion. The present analysis focuses on home treatment of pneumonia with cefotaxime delivered via an ambulatory infusion pump and the potential of this therapy to reduce the length of hospital stay. Data presented here and in previously published studies of a variety of serious infections show that admitting patients into home intravenous antibiotic therapy programs can significantly reduce, and sometimes eliminate, hospital stay, while providing efficacy and safety comparable to that expected from hospital treatment. Analysis of hospitalization patterns for pneumonia patients placed on cefotaxime therapy delivered via portable infusion pump revealed that length of stay was only 10% of that for the reference diagnosis-related group. Despite the great potential cost savings, there are reimbursement barriers to the use of home infusion antibiotics. However, healthcare reform may promote greater acceptance, use, and support of home infusion technology.

Third-generation cephalosporins. A plea to save them for specific infections

Third-generation cephalosporins are indicated for treatment of sexually transmitted diseases, resistant salmonellosis, and infections in the febrile leukopenic host. The practicing physician must weigh the expanding role of these agents against their limitations. Some potential problems include bleeding (confined to the use of moxalactam [Moxam] or cefoperazone [Cefobid]), a reaction like that to disulfiram (Antabuse) when combined with alcohol (also confined to the use of moxalactam or cefoperazone), and superinfection. A prolonged course of treatment entails significant expense. Further evaluation and clinical experience is necessary before use of third-generation cephalosporins for some of the newer indications (eg, late stages of Lyme disease, neurosyphilis) becomes routine medical practice.