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Padigos J, Reid S, Kirby E, Anstey C, Broom J. Nursing experiences in antimicrobial optimisation in the intensive care unit: A convergent analysis of a national survey. Aust Crit Care 2023; 36:769-781. [PMID: 36404269 DOI: 10.1016/j.aucc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent evidence highlights the need for an interdisciplinary approach to antimicrobial stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive care unit (ICU) remains understudied. OBJECTIVE The objective of this study was to explore nurses' perceptions and experiences of antimicrobial optimisation or stewardship in ICUs in Australia. METHODS An anonymous web-based survey was deployed nationally in early 2021 through two ICU nursing networks. Associations between survey responses were analysed descriptively and by using nonparametric tests (with statistical significance established at p ≤ 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation and reporting of quantitative and qualitative data were integrated. RESULTS A total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence of AMS education and training for nurses in their ICUs. Only about half (108/226; 48%) of the nurses were confident to question prescribers when they considered that the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive antimicrobial discussions, moral distress, and potential workload burden were seen as potential barriers/challenges to engagement. CONCLUSION The multifactorial barriers identified that inhibit nurses from performing AMS tasks could be addressed by strengthening interprofessional education at all levels and by applying practical AMS interventions that are inclusive for nursing participation. A purposeful culture change that fosters psychological safety and collaborative practice is paramount to supporting nurses in these roles.
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Affiliation(s)
- Junel Padigos
- Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia; School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Simon Reid
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney NSW, 2052, Australia
| | - Chris Anstey
- School of Medicine and Dentistry, Griffith University, Birtinya, QLD, 4575, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Jennifer Broom
- Infectious Diseases Research Network, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
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Assessment of Intravenous Antibiotics to Peroral Antibiotics Conversion Practice and Its Associated Factor at University of Gondar Comprehensive Specialized Hospital: Prospective Observational Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:8395424. [PMID: 36277733 PMCID: PMC9581647 DOI: 10.1155/2022/8395424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Background Improper utilization of antibiotics harms the patient, the public, and the economy. The overuse of injections is one of the key factors in the irrational use of medicines. However, little is known about intravenous (IV) to peroral (PO) conversion practice in the Ethiopian healthcare setting, specifically in the Northwest part of Ethiopia. Objective To assess antibiotics IV to PO conversion practice and its associated factors at the internal medicine ward of the University of Gondar Comprehensive and Specialized Hospital (UOGCSH). Method A prospective observational study was conducted on 324 study participants who were admitted to the University of Gondar Specialized Hospital from October 3 to November 14, 2021. A systematic random sampling technique was employed to select the study participants. Stata version 14.2 was used for the analysis. Descriptive statistics result was presented using mean and standard deviation. Logistic regression analysis was done to determine the association between independent variables and dependent variables. The association between independent variables and dependent variables was tested at 95% CI and P value≤ 0.05 was considered statistical significance. Result A total of 324 study participants were included in the study, and the mean age of the patients was 41.4 ± 18.6. Of the 324 study participants, 63.3% were male. The most frequently prescribed antibiotics used for empiric treatment were ceftriaxone (45.4%), followed by metronidazole (33.2%), and cloxacillin (11.4%). A total of 34.5.57% of patients who took antibiotics were converted to PO antibiotics. The most frequently converted type of conversion practice was sequential (23.1%), followed by the switch type of conversion (7.4%). Tachypnea, unavailability of medication, higher temperature, hospital stay greater than 10.78-days, and the presence of comorbidity were predictors of IV medications not being converted to PO medications. Conclusion Intravenous to peroral conversion practice was infrequent. The most frequently applied conversion practice was sequential type conversion practice, followed by switch type of conversion practice. IV to PO conversion practice was significantly associated with tachypnea, unavailability of medication, higher temperature, hospital stay greater than 10.78-days, and comorbidity. Awareness of IV to PO conversion practice and short-term training for healthcare teams is vital for better antibiotic conversion practice.
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Salah E, Abouelfetouh MM, Pan Y, Chen D, Xie S. Solid lipid nanoparticles for enhanced oral absorption: A review. Colloids Surf B Biointerfaces 2020; 196:111305. [DOI: 10.1016/j.colsurfb.2020.111305] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/24/2020] [Accepted: 08/01/2020] [Indexed: 12/26/2022]
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Hakami AY, Alshehri FS, Althobaiti YS, Sari Y. Effects of orally administered Augmentin on glutamate transporter 1, cystine-glutamate exchanger expression and ethanol intake in alcohol-preferring rats. Behav Brain Res 2016; 320:316-322. [PMID: 27993695 DOI: 10.1016/j.bbr.2016.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/06/2016] [Accepted: 12/15/2016] [Indexed: 12/29/2022]
Abstract
Alcohol dependence is associated with deficits in glutamate uptake and impairment of glutamate homeostasis in different brain reward regions. Glutamate transporter subtype 1 (GLT-1), cystine-glutamate exchanger (xCT) and glutamate/aspartate transporter (GLAST) are one of the key players in regulating extracellular glutamate concentration in the brain. Parenteral treatment with ceftriaxone, β-lactam antibiotic, has been reported to attenuate ethanol consumption and reinstatement to cocaine-seeking behavior, in part, by restoring the expression of GLT-1 and xCT in mesocorticolimbic brain regions in rats. In this study, we focused to test Augmentin (amoxicillin/clavulanate), which can be administered orally to subjects. Therefore, we examined the effects of orally administered Augmentin on ethanol intake as well as GLT-1, xCT and GLAST expression in male alcohol-preferring (P) rats. We found that orally administered Augmentin significantly attenuated ethanol consumption in P rats as compared to the vehicle-treated group. Importantly, the attenuation in ethanol consumption was associated with a significant upregulation of GLT-1 and xCT expression in nucleus accumbens (NAc) and prefrontal cortex (PFC). There was no effect of orally administered Augmentin on GLAST expression in either NAc or PFC. These findings present strong evidence that oral administration of Augmentin can be used as an alternative to parenteral treatment.
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Affiliation(s)
- Alqassem Y Hakami
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
| | - Fahad S Alshehri
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
| | - Yusuf S Althobaiti
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
| | - Youssef Sari
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA.
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Cyriac JM, James E. Switch over from intravenous to oral therapy: A concise overview. J Pharmacol Pharmacother 2014; 5:83-7. [PMID: 24799810 PMCID: PMC4008927 DOI: 10.4103/0976-500x.130042] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/12/2013] [Accepted: 10/21/2013] [Indexed: 02/07/2023] Open
Abstract
Majority of the patients admitted to a hospital with severe infections are initially started with intravenous medications. Short intravenous course of therapy for 2-3 days followed by oral medications for the remainder of the course is found to be beneficial to many patients. This switch over from intravenous to oral therapy is widely practiced in the case of antibiotics in many developed countries. Even though intravenous to oral therapy conversion is inappropriate for a patient who is critically ill or who has inability to absorb oral medications, every hospital will have a certain number of patients who are eligible for switch over from intravenous to oral therapy. Among the various routes of administration of medications, oral administration is considered to be the most acceptable and economical method of administration. The main obstacle limiting intravenous to oral conversion is the belief that oral medications do not achieve the same bioavailability as that of intravenous medications and that the same agent must be used both intravenously and orally. The advent of newer, more potent or broad spectrum oral agents that achieve higher and more consistent serum and tissue concentration has paved the way for the popularity of intravenous to oral medication conversion. In this review, the advantages of intravenous to oral switch over therapy, the various methods of intravenous to oral conversion, bioavailability of various oral medications for the switch over program, the patient selection criteria for conversion from parenteral to oral route and application of intravenous to oral switch over through case studies are exemplified.
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Affiliation(s)
- Jissa Maria Cyriac
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Health Science Campus, Amrita Vishwa Vidyapeetham University, Ponekkara, Kochi, Kerala, India
| | - Emmanuel James
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Health Science Campus, Amrita Vishwa Vidyapeetham University, Ponekkara, Kochi, Kerala, India
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Buyle FM, Metz-Gercek S, Mechtler R, Kern WV, Robays H, Vogelaers D, Struelens MJ. Prospective multicentre feasibility study of a quality of care indicator for intravenous to oral switch therapy with highly bioavailable antibiotics. J Antimicrob Chemother 2012; 67:2043-6. [PMID: 22566589 DOI: 10.1093/jac/dks145] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Enhanced oral (po) bioavailability of antimicrobial drugs allows conversion to po therapy once a patient meets defined clinical criteria. This can reduce length of hospital stay, healthcare costs and risk of complications related to intravenous (iv) access. We developed a quality indicator for assessing the appropriate iv-to-po switch of bioavailable antibiotics and evaluated its feasibility and clinical relevance across acute healthcare systems. METHODS The study was designed as a multicentre, multinational observational audit. The indicator was the proportion of inappropriate iv treatments at any point in time in adult patients treated with fluoroquinolones, clindamycin, linezolid or metronidazole. Treatments were prospectively evaluated by a trained physician or clinical pharmacist using predefined clinical criteria. The feasibility of the indicator was evaluated by measuring data availability, data collection workload and sensitivity to improvement RESULTS Data were collected over a 3 month period in five university hospitals in Austria, Belgium and Germany and iv treatment was assessed in 211 patients. The indicator was measurable in 99.1% of cases. By intention-to-treat analysis, 37.0% (95% CI 30.5-43.9) of treatments were inappropriate, ranging from 17.5% to 53.8% across hospitals. The median time needed for case assessment and documentation was 29 min. CONCLUSIONS This quality indicator was found to be generally feasible in hospitals across three European countries, and informative about the local need for clinical quality improvement.
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Affiliation(s)
- F M Buyle
- Pharmacy Department, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Buyle F, Vogelaers D, Peleman R, Van Maele G, Robays H. Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital. ACTA ACUST UNITED AC 2010; 32:404-10. [PMID: 20358404 DOI: 10.1007/s11096-010-9384-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study measured the impact of three interventions for physicians, in order to implement guidelines for sequential therapy (intravenous to oral conversion) with fluoroquinolones. SETTING A Belgian university hospital with 1,065 beds. Method The first intervention consisted of the hospital-wide publication of guidelines in the local drug letter towards all prescribers. The consumption of fluoroquinolones was measured by means of an interrupted time-series (ITS) analysis 21 months before (period A) and 24 months after publication (period B). The second intervention was an educational interactive session, by infectious disease specialists, to the medical staff of orthopaedics and endocrinology. The third intervention comprised a proactive conversion programme on the abdominal surgery, gastro-enterology and plastic surgery wards, where pharmacists attached a pre-printed note with a suggestion to switch to an oral treatment every time a patient met the criteria for switching. The second and third intervention took place 6 months after the first intervention. Fluoroquinolone treatments were evaluated during a 2 month period before (group 1) and after the introduction of the second (group 2) and third (group 3) intervention. MAIN OUTCOME MEASURE The monthly ratio of intravenous versus total fluoroquinolone consumption (daily defined doses per 1,000 bed days) was measured to assess the impact of the first intervention. The impact of the second and third intervention was measured in relation to the number of days that intravenous therapy continued beyond the day that the patient fulfilled the criteria for sequential therapy and the antibiotic cost. RESULTS The ITS demonstrated a reduction of 3.3% in the ratio of intravenous versus total consumption after the publication of the guidelines (P = 0.011). In group 1, patients were treated intravenously for 4.1 days longer than necessary. This parameter decreased in group 2 to 3.5 days and in group 3 to 1.0 day (P = 0.006). The mean additional cost for longer intravenous treatment decreased from 188.0 euro in group 1, to 103.0 euro in group 2 and 44.0 euro in group 3 (P = 0.037). CONCLUSION This study demonstrated that active implementation of guidelines is necessary. A proactive conversion programme by a pharmacist resulted in a reduction in the duration of the intravenous treatment, and the treatment cost.
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Affiliation(s)
- Franky Buyle
- Pharmacy Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
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Troselj-Vukic B, Poljak I, Milotic I, Slavic I, Nikolic N, Morovic M. Efficacy of pefloxacin in the treatment of patients with acute infectious diarrhoea. Clin Drug Investig 2007; 23:591-6. [PMID: 17535072 DOI: 10.2165/00044011-200323090-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate the clinical and bacteriological efficacy of 5- and 7-day pefloxacin therapy in patients with acute infectious diarrhoea. PATIENTS AND STUDY DESIGN Eighty-two adult patients with acute infectious diarrhoea were randomly divided into three groups: group 1 (n = 20) received 5 days of treatment with pefloxacin, group 2 (n = 27) was assigned to a 7-day pefloxacin protocol, and group 3 (n = 35) was treated symptomatically. The daily dose of pefloxacin was 400mg orally. Clinical and bacteriological response was analysed on the third, fifth and seventh days of treatment as well as 1 and 4 weeks after the end of treatment. The study was an open-labelled, prospective clinical trial. RESULTS In the 47 patients (100%) of both pefloxacin groups a clinical improvement was noted on the third day compared with the control group, where this occurred on day 7. Bacteriological eradication was verified on the fifth day in 18 patients (90%) from group 1 and in 25 patients (93%) from group 2; they all had negative stool cultures 1 and 4 weeks after therapy was completed. Only 22 patients (63%) in the control group had negative stool cultures on the seventh day of treatment, but 4 weeks later all of them were negative. CONCLUSION There was no difference in clinical (p = 0.232) and bacteriological (p = 0.972) efficacy between the 5- and 7-day pefloxacin treatment protocols. However, both protocols differed significantly in clinical improvement (p < 0.001) and bacteriological eradication (p = 0.017) from the control group.
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Affiliation(s)
- Biserka Troselj-Vukic
- Department of Infectious Diseases, University Hospital Centre Rijeka, Rijeka, Croatia
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Wickens HJ, Jacklin A. Impact of the Hospital Pharmacy Initiative for promoting prudent use of antibiotics in hospitals in England. J Antimicrob Chemother 2006; 58:1230-7. [PMID: 17030518 DOI: 10.1093/jac/dkl405] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In July 2003, the UK Department of Health announced an allocation of 12 million pounds sterling to hospital pharmacists to improve the monitoring and control of anti-infective use over the ensuing 3 year period (the Hospital Pharmacy Initiative, or HPI). Chief Pharmacists were asked to use this money for developments to promote prudent antibiotic use and monitoring of antimicrobials within their Trusts. This study aimed to evaluate the impact of the HPI funding, which at the time had been in place for nearly 2 years, on pharmacy activities in this area. METHODS A postal questionnaire was sent to the pharmacy department of each acute hospital Trust in England, aiming to provide a descriptive overview of the activities of hospital pharmacy staff in the field of anti-infectives and to explore the extent to which these activities were made possible by the HPI funding. RESULTS One hundred and forty-one specialist antimicrobial pharmacy staff were employed in 130 responding Trusts; 89% were pharmacists, 7% pharmacy technicians and the remainder administrative staff. Three-quarters of these staff had been employed due to the funding, resulting in review of antimicrobial prescribing guidelines, antibiotic audit projects and multidisciplinary work with Microbiology/Infectious Diseases staff. Thirteen Trusts gave details of drug acquisition cost savings; over the course of a year, these Trusts saved 1.1 million pounds sterling in total. CONCLUSIONS The HPI funding has facilitated greater interaction between Pharmacy and Microbiology/Infectious Diseases departments than was previously possible. Significant reductions in antibiotic acquisition costs have been demonstrated, though further work is warranted to fully establish the impact of pharmacy activities on clinical and microbiological outcomes.
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Affiliation(s)
- H J Wickens
- Pharmacy Department, St Mary's NHS Trust, London W2 1NY, UK.
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Enzweiler KA, Bosso JA, White RL. A novel method of estimating cost of therapy by using patient population characteristics: analysis of fluoroquinolones in various populations with different distributions of renal function. Pharmacotherapy 2003; 23:925-32. [PMID: 12885105 DOI: 10.1592/phco.23.7.925.32732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Formulary decisions regarding a given drug class are often made in the absence of patient outcome and/or sophisticated pharmacoeconomic data. Analyses that consider factors beyond simple acquisition costs may be useful in such situations. For example, the cost implications of using manufacturers' recommendations for dosing in patients with renal dysfunction may be important, depending on the distribution of various levels of renal function within a patient population. METHODS Using four 1000-patient populations representing different renal function distributions and a fifth population of our medical center's distribution, we determined the costs of therapy for intravenous and oral levofloxacin, gatifloxacin, and moxifloxacin for a 10-day course of therapy for community-acquired pneumonia. Costs considered were average wholesale prices (AWPs), 50% of AWP, or same daily price, plus intravenous dose preparation and administration costs when applicable. Costs for each renal function distribution were examined for significant differences with an analysis-of-variance test. Also, costs of failing to adjust dosing regimens for decreased renal function were determined. RESULTS Differences in fluoroquinolone costs (AWP, 50% AWP, or when matched as the same daily price) among the populations were found. When considering same daily prices, differences among populations ranged from about 35,000 dollars with intravenous gatifloxacin to more than 51,000 dollars for intravenous levofloxacin (all fluoroquinolones, p>0.05). Within a population, differences in costs among the intravenous fluoroquinolones ranged from 47,000-99,000 dollars. Rank orders of the drugs and population costs of therapy were affected by the pricing structure used and varied by the specific population and drug. Differences among the fluoroquinolones or populations were much smaller (<2100 dollars) when considering oral regimens. Costs potentially incurred by failing to adjust dosing for renal function were substantial. CONCLUSION Formulary decisions can be facilitated by considering factors such as patient characteristics and related dosing in addition to simple acquisition costs. In our example, consideration of the distribution of renal function within a given patient population and related dosing for these fluoroquinolones revealed potentially important differences within the class.
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Affiliation(s)
- Kevin A Enzweiler
- Anti-Infective Research Laboratory, College of Pharmacy, Medical University of South Carolina, Charleston 29425, USA
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Curtis C, Fitzpatrick R, Marriott JF. An evaluation of quinolone prescribing in a group of acute hospitals: development of an objective measure of usage. PHARMACY WORLD & SCIENCE : PWS 2002; 24:61-6. [PMID: 12061135 DOI: 10.1023/a:1015563416551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To develop an objective measure to enable hospital Trusts to compare their use of antibiotics. DESIGN Self-completion, postal questionnaire with telephone follow up. SAMPLE 4 hospital trusts in the English Midlands. RESULTS The survey showed that it was possible to collect data concerning the number of Defined Daily Doses (DDD's) of quinolone antibiotic dispensed per Finished Consultant Episode (FCE) in each Trust. In the 4 trusts studied the mean DDD/FCE was 0.197 (range 0.117 to 0.258). This indicates that based on a typical course length of 5 days, 3.9% of patient episodes resulted in the prescription of a quinolone antibiotic. Antibiotic prescribing control measures in each Trust were found to be comparable. CONCLUSION The measure will enable Trusts to objectively compare their usage of quinolone antibiotics and use this information to carry out clinical audit should differences be recorded. This is likely to be applicable to other groups of antibiotics.
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Affiliation(s)
- C Curtis
- Queen's Hospital, Burton upon Trent, Straffordshire, UK.
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Dresser LD, Niederman MS, Paladino JA. Cost-effectiveness of Gatifloxacin vs Ceftriaxone With a Macrolide for the Treatment of Community-Acquired Pneumonia. Chest 2001; 119:1439-48. [PMID: 11348951 DOI: 10.1378/chest.119.5.1439] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To determine the cost-effectiveness of sequential IV to oral gatifloxacin therapy vs IV ceftriaxone with or without IV erythromycin to oral clarithromycin therapy to treat community-acquired pneumonia (CAP) patients requiring hospitalization. PATIENTS Two hundred eighty-three patients enrolled in a randomized, double-blind, clinical trial were eligible for inclusion in the cost-effectiveness analysis. METHODS Data collected included patient demographics, clinical and microbiological outcomes, length of stay (LOS), and antibiotic-related LOS (LOSAR). Costs evaluated include drug acquisition (level 1); plus costs of preparation, dispensing, and administration, treating adverse events, and clinical failures (level 2); plus hospital per diem costs (level 3). Robustness of economic findings was tested using sensitivity analyses. RESULTS Two hundred three patients were clinically and economically evaluable (98 receiving gatifloxacin and 105 receiving ceftriaxone). IV erythromycin was administered to 35 patients in the ceftriaxone-treated group. Oral conversion was achieved in 98% of patients in each group. Clinical cure and microbiological eradication rates did not differ statistically (98% and 97% with gatifloxacin vs 92% and 92% with ceftriaxone, respectively). Overall, neither geometric mean LOS nor LOSAR differed significantly (4.2 days and 4.1 days with gatifloxacin vs 4.9 days and 4.9 days with ceftriaxone, respectively). Treatment failures in the ceftriaxone group contributed to a mean incremental increase in LOSAR of 1.09 days and increased mean cost per patient. The geometric mean costs per patient (level 3) were $5,109 for gatifloxacin and $6,164 for ceftriaxone (p = 0.011). The cost-effectiveness ratios (mean cost per expected success) were $5,236:1 and $7,047:1 for gatifloxacin and ceftriaxone, respectively. CONCLUSIONS Gatifloxacin monotherapy for CAP patients requiring hospitalization is clinically effective and provides an economic advantage compared to the regimen of ceftriaxone with or without erythromycin IV with a switch to oral clarithromycin.
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Affiliation(s)
- L D Dresser
- Clinical Pharmacokinetics Laboratory, State University of New York at Buffalo, USA
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Paladino JA, Fong LD, Forrest A, Ramphal R. Cost effectiveness of cephalosporin monotherapy and aminoglycoside/ureidopenicillin combination therapy. For the treatment of febrile episodes in neutropenic patients. PHARMACOECONOMICS 2000; 18:369-381. [PMID: 15344305 DOI: 10.2165/00019053-200018040-00005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the relative cost effectiveness of cephalosporin monotherapy options and aminoglycoside/ureidopenicillin combination therapy for the treatment of febrile episodes in adult patients with neutropenia. DESIGN AND SETTING This was a retrospective cost-effectiveness analysis conducted from the institutional perspective. METHODS The analysis was based on 741 febrile episodes in adult patients with neutropenia enrolled in 5 randomised trials: 3 comparing monotherapy with ceftazidime or cefepime, and 2 comparing cefepime monotherapy versus aminoglycoside/ureidopenicillin combination therapy. Resource utilisation included costs for study antibacterials, treatment of adverse effects and failures, and hospitalisation. The primary end-point was the overall cost of treatment per patient. Cost-effectiveness ratios were also analysed. RESULTS No significant differences in clinical success rates were detected. Median per-patient costs in the monotherapy comparisons were $US7849 for cefepime and $US7788 for ceftazidime [1997 values; not significantly different (NS)]. Corresponding costs for the monotherapy versus combination therapy comparisons were $US9780 for cefepime and $US10 159 for gentamicin/ureidopenicillin (NS). Despite a higher acquisition cost for cefepime, there were no statistically significant differences in cost effectiveness compared with either ceftazidime monotherapy or gentamicin/ureidopenicillin combination therapy. Sensitivity analyses revealed that monotherapy can be cost effective compared with combination therapy in many situations. CONCLUSION There were no economic differences between the 3 regimens tested. Therefore drug cost should not be a deciding factor when choosing antibacterial therapy for the treatment of febrile episodes in adult patients with neutropenia.
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Affiliation(s)
- J A Paladino
- The Clinical Pharmacokinetics Laboratory Millard Fillmore Hospitals, Buffalo, New York 14221, USA.
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Sánchez-Navarro A, Sánchez Recio MM. Basis of anti-infective therapy: pharmacokinetic-pharmacodynamic criteria and methodology for dual dosage individualisation. Clin Pharmacokinet 1999; 37:289-304. [PMID: 10554046 DOI: 10.2165/00003088-199937040-00002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Antimicrobial therapy should be designed on the basis of microbiological, as well as pharmacokinetic, criteria; microbiological parameters provide information about the susceptibility of the pathogen responsible for the infectious process while pharmacokinetic parameters give information about the potential ability of the drug in question to reach and remain at the sites of infection in the body. Microbiological parameters such as the minimum inhibitory concentration, minimum bactericidal concentration, bacterial titre, bactericidal rate and 'post-antibiotic effect' (PAE) must be considered. Among the pharmacokinetic parameters, the maximum serum concentration at steady state (CmaxSS), area under the concentration-time curve (AUC) and length of time that the serum concentrations exceed a particular value are the most useful in this context. Different relationships between these parameters, known as efficacy indices, have been established to predict the potential efficacy of antibacterial therapy. Antimicrobial dosage individualisation should be based on the optimisation of the efficacy index that best correlates with patient response. It seems appropriate to establish the degree of correlation among the different efficacy indices and clinical response observed in patients by means of a correlation analysis. This type of analysis can be either retrospective or prospective and may be based on linear or maximum response models. Simulation of the plasma concentration curves obtained with the particular regimen administered offers a methodology which is easy to apply and provides the pharmacokinetic information necessary to calculate the different efficacy indices. Information about the susceptibility of the pathogen to the antibacterial in question and about the response to the treatment used is also necessary for the correlation analysis. This type of analysis determines which of the indices is best correlated with efficacy and, hence, is the index to be optimised when attempting to individualise antibacterial therapy for different situations.
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Affiliation(s)
- A Sánchez-Navarro
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Salamanca, Spain.
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Partsch DJ, Paladino JA. Cost-effectiveness comparison of sequential ofloxacin versus standard switch therapy. Ann Pharmacother 1997; 31:1137-45. [PMID: 9337437 DOI: 10.1177/106002809703101004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare the cost-effectiveness of sequential intravenous-to-oral ofloxacin versus intravenous-to-oral standard switch therapy for the treatment of patients with sepsis who are hospitalized with bacterial infections. DESIGN Cost-effectiveness analysis from a provider perspective, including resources important to an integrated healthcare network, of a randomized, open-label, controlled, clinical trial. SETTING Millard Fillmore Health System, Buffalo, NY. PATIENTS Hospitalized adults requiring parenteral antibiotics for a complicated urinary tract infection, lower respiratory tract infection, or skin and soft tissue infection. INTERVENTIONS Sequential intravenous-to-oral ofloxacin or standard intravenous-to-oral switch antibiotics. OUTCOME MEASURES Clinical outcomes and direct costs associated with hospitalization, primary physician services, specialist physician services, and outpatient care. RESULTS Eighty-two of 89 patients randomized into the two treatment groups were evaluable. Standard switch therapy failed with 12 patients versus 10 patients receiving ofloxacin. Complete economic data were available for 74 patients. Sequential ofloxacin therapy resulted in a 1-day-shorter antibiotic-related hospitalization without evidence of recurrent infection during the posttherapy follow-up evaluations. An average cost savings of $399 per patient was achieved in the sequential ofloxacin group. Although this difference did not attain statistical significance (probably due to the large variance), it is an economically significant finding. The cost-effectiveness ratios were $5735 per successful outcome for the standard switch therapy group versus $5126 per successful outcome in the sequential ofloxacin group. CONCLUSIONS Sequential ofloxacin was as effective and consistently less expensive than standard switch antibiotics in the initial evaluation and in the sensitivity analysis of room cost and drug acquisition cost. Standard switch therapy would have to be greater than 25% more effective than sequential ofloxacin therapy to change the economic decision.
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Affiliation(s)
- D J Partsch
- State University of New York at Buffalo, USA
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