RESUMEN
New advances in human immunodeficiency virus (HIV) monitoring and therapeutics have led to dramatic changes in the course of HIV disease. We evaluated our closed clinic of 425 HIV patients over the period 1995-1998 to determine the cost effectiveness of these changes in care. We found that the costs of antiretroviral therapy tripled over the period of observation, but that these increases were largely offset by major declines in inpatient and home health expenditures. In addition, we found that annual mortality among our HIV patients had declined by 90%. We calculated that the cost per life-year gained is about $17,500, which compares favorably with medical expenditures for renal dialysis or advanced cardiac disease.
Asunto(s)
Antivirales/economía , Antivirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/economía , Costos de la Atención en Salud/tendencias , California , Análisis Costo-Beneficio , Infecciones por VIH/mortalidad , Hospitales Militares , Humanos , Personal Militar , Estados UnidosAsunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición Profesional/prevención & control , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Hospitales con 300 a 499 Camas , Hospitales Militares , Humanos , Farmacéuticos , Servicio de Farmacia en HospitalAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Ácidos Bóricos/uso terapéutico , Candidiasis Vulvovaginal/prevención & control , Administración Intravaginal , Adulto , Antifúngicos/uso terapéutico , Candidiasis Vulvovaginal/etiología , Farmacorresistencia Microbiana , Femenino , Fluconazol/uso terapéutico , Humanos , SupositoriosRESUMEN
OBJECTIVE: To report a case of reversible vancomycin-associated neutropenia occurring during long-term therapy with vancomycin using weight and age-adjusted dosing. CASE SUMMARY: A 2-year-old boy was started on vancomycin therapy for presumed endocarditis resulting from his ventriculoseptal defect. After 18 days of treatment, neutropenia with an absolute neutrophil count (ANC) of 990 x 10(6) cells/L was noted. The neutropenia progressed over the next 3 days and reached a nadir concentration of 459 x 10(6) cells/L. Vancomycin therapy was discontinued after 17 days (antibiotic day 20). A rise in the ANC occurred within 2 days of discontinuation. An improved ANC of 1672 x 10(6) cells/L occurred within 5 days. Vancomycin serum concentrations remained within an acceptable range: a peak of 30 micrograms/mL and a trough of 9 micrograms/mL. DISCUSSION: Case reports in the literature of vancomycin-associated neutropenia in adults were briefly reviewed and compared. The onset and resolution and mechanism of vancomycin-induced neutropenia were studied. The potential relationship between vancomycin, weight-, and age-adjusted dosing and the occurrence of neutropenia in our pediatric patient was postulated. CONCLUSIONS: Vancomycin is identified as a possible cause of drug-induced neutropenia. More data are needed that clearly indicate vancomycin as the offending agent in children. The vancomycin-induced neutropenia is believed to be immunologically based and independent of drug concentrations.