RESUMEN
The aim of cystic fibrosis (CF) care is to improve both the life expectancy and quality of life of patients. However, rising costs and limited resources of health services must be taken into account. There are many different antibiotic strategies for therapy of Pseudomonas aeruginosa infection in CF patients. In this 5-year retrospective study we found that the cost of treatment of initial infection is considerably lower than the cost of treating chronic P. aeruginosa infections. The percentage distribution of costs of antibiotic treatment in relationship to the administration route was considerably different between outpatients and inpatients. We observed an increase in antibiotic costs with the age of the patient and the decrease in FEV(1)values. The implementation of early eradication treatment, in addition to decreasing the prevalence of patients chronically infected by P. aeruginosa, might also bring about a notable decrease in costs.
Asunto(s)
Antibacterianos/economía , Costo de Enfermedad , Fibrosis Quística/tratamiento farmacológico , Fibrosis Quística/economía , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/economía , Adulto , Antibacterianos/uso terapéutico , Ceftazidima/economía , Ceftazidima/uso terapéutico , Preescolar , Enfermedad Crónica , Ciprofloxacina/economía , Ciprofloxacina/uso terapéutico , Ácidos Clavulánicos/economía , Ácidos Clavulánicos/uso terapéutico , Colistina/economía , Colistina/uso terapéutico , Fibrosis Quística/complicaciones , Humanos , Meropenem , Infecciones por Pseudomonas/etiología , Pseudomonas aeruginosa , Estudios Retrospectivos , Tienamicinas/economía , Tienamicinas/uso terapéutico , Ticarcilina/economía , Ticarcilina/uso terapéutico , Tobramicina/economía , Tobramicina/uso terapéuticoRESUMEN
BACKGROUND: Patients with diabetes mellitus, particularly those with poor glucose control, commonly experience various medical complications related to the disease (eg, renal impairment, decreased peripheral vascular circulation, suppressed immune function). Infections of the lower extremities can range from superficial cellulitis to ulcerative, deep soft-tissue infections to osteomyelitis that necessitates some degree of amputation. OBJECTIVE: This study compared the efficacy, tolerability, and cost differences associated with the use of metronidazole plus ceftriaxone (MTZ/CTX) given once daily with those of ticarcillin/clavulanate potassium (T/C) given every 6 hours in hospitalized older males with diabetic lower-extremity infections. METHODS: This prospective, open-label study was conducted at a Veterans Affairs Medical Center. Male patients with diabetes and a lower-extremity infection were randomized to receive MTZ/CTX 1 g once daily or T/C 3.1 g every 6 hours. Treatment success was determined at 96 hours or on discontinuation of antibiotic. Success was measured in terms of body temperature <38.3 degrees C (100.6 degrees F), normalization of the finger-stick blood sugar concentration, improvement in wound staging, or a white blood cell count <10,000 cells/mm3. Medication acquisition costs per treatment arm were calculated and compared. RESULTS: Seventy patients were enrolled in the study (36 MTZ/CTX, 34 T/C). The study population had a mean (SD) age of 63.8 (10.8) years, a duration of diabetes of 12.4 (9.1) years, 0.5 (0.7) diabetes-related comorbidities, and an initial creatinine clearance of 67.1 (26.0) mL/min. There were no significant differences between groups at randomization. At 96 hours, treatment success was achieved in 31 (86%) patients in the MTZ/CTX group, compared with 28 (82%) patients in the T/C group (P=NS). Twenty-six patients were considered successfully treated on the final day of therapy in both the MTZ/CTX group (72%) and the T/C group (76%) (P=NS). There were no significant differences in primary or secondary measures of success between the 2 groups. No single or multiple baseline factors predicted treatment success or failure. No patient experienced adverse events considered related to study medication. MTZ/CTX was associated with savings of $61.06 per hospital admission, or $2198.05 for all patients who received this combination. CONCLUSION: In this population of older males, once-daily MTZ/CTX was as well tolerated and effective as T/C in the treatment of diabetic lower-extremity infections and was associated with reduced institutional costs.
Asunto(s)
Antibacterianos/economía , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Pie Diabético/complicaciones , Costos de Hospital , Anciano , Antibacterianos/efectos adversos , Infecciones Bacterianas/etiología , Ceftriaxona/administración & dosificación , Ceftriaxona/economía , Ceftriaxona/uso terapéutico , Ácidos Clavulánicos/administración & dosificación , Ácidos Clavulánicos/economía , Ácidos Clavulánicos/uso terapéutico , Ahorro de Costo , Esquema de Medicación , Combinación de Medicamentos , Costos de los Medicamentos , Quimioterapia Combinada , Hospitalización , Humanos , Masculino , Metronidazol/administración & dosificación , Metronidazol/economía , Metronidazol/uso terapéutico , Estudios Prospectivos , Ticarcilina/administración & dosificación , Ticarcilina/economía , Ticarcilina/uso terapéutico , Resultado del TratamientoRESUMEN
An open labeled randomized trial comparing the efficacy and cost of empirically applied cefepime (C) as monotherapy versus combination therapy consisting of ticarcillin and clavulanate potassium and aztreonam (T/A) was performed in febrile neutropenic patients following high-dose chemotherapy (HDC) +/- radiation, with or without peripheral blood stem cell support. Over a 28-month period, 126 patients were screened and included in the study. Using afebrile status following 3 days of therapy as a primary endpoint, both regimens produced comparable clinical response rates (C = 55% vs. T/A = 61%). Also, the use of vancomycin for resistant gram-positive infections and alteration of gram-negative infection coverage was similar in both groups (C = 40% vs. T/A = 47% and C = 29% vs. T/A = 24%). Both treatment groups had similar needs for empirical antifungal therapy (C = 25% vs. T/A = 22%). There was a postrandomization difference between the two groups in that the "C" group had a significantly higher number of allogeneic transplants and non-stem-cell-supported patients, whereas the "T/A" group had a significantly greater number of autologous peripheral blood stem cell patients (p < 0.0001). Despite this difference, the C group had a significantly lower cost ratio than the T/A group (p = 0.016). In conclusion, we have shown that C treatment of febrile neutropenic patients following HDC results in similar efficacy and lower cost when compared to T/A, despite the inclusion of higher risk patients in the C group.
Asunto(s)
Antibacterianos/uso terapéutico , Aztreonam/uso terapéutico , Cefalosporinas/uso terapéutico , Ácido Clavulánico/uso terapéutico , Huésped Inmunocomprometido , Neoplasias/tratamiento farmacológico , Neoplasias/inmunología , Infecciones Oportunistas/prevención & control , Ticarcilina/uso terapéutico , Adulto , Anciano , Antibacterianos/economía , Antineoplásicos/uso terapéutico , Aztreonam/economía , Cefepima , Cefalosporinas/economía , Ácido Clavulánico/economía , Costos y Análisis de Costo , Quimioterapia Combinada/economía , Quimioterapia Combinada/uso terapéutico , Femenino , Fiebre , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/radioterapia , Neutropenia , Infecciones Oportunistas/inmunología , Trasplante de Células Madre de Sangre Periférica , Ticarcilina/economíaRESUMEN
STUDY OBJECTIVE: To evaluate the efficacy and cost of treatment with two beta-lactam/beta-lactamase-inhibitor combinations. DESIGN: Retrospective, open-label multicenter study. SETTING: Fifty-four hospitals across the United States. PATIENTS: Eight hundred ninety patients with skin and soft tissue, intraabdominal, gynecologic, respiratory, urinary tract, or other infections that required parenteral antibiotic therapy. INTERVENTION: Patients were administered either ampicillin-sulbactam 1.5 or 3.0 g every 6 hours or ticarcillin-clavulanate 3.1 g every 6 hours. MEASUREMENTS AND MAIN RESULTS: The agents did not differ significantly in efficacy for most infections; although, ampicillin-sulbactam was bacteriologically superior to ticarcillin-clavulanate in the treatment of intraabdominal infections (p=0.0011). Costs of ampicillin-sulbactam, particularly the 1.5-g dose, were lower than those of ticarcillin-clavulanate for skin and soft tissue (p<0.001), intraabdominal (p=0.005), and respiratory tract (p<0.001) infections. CONCLUSION: Ampicillin-sulbactam provides effective coverage for patients with the above infections and is as effective as the broader-spectrum agent.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Quimioterapia Combinada/uso terapéutico , Adulto , Anciano , Ampicilina/economía , Ampicilina/uso terapéutico , Análisis de Varianza , Ácidos Clavulánicos/economía , Ácidos Clavulánicos/uso terapéutico , Costos de los Medicamentos , Quimioterapia Combinada/economía , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sulbactam/economía , Sulbactam/uso terapéutico , Ticarcilina/economía , Ticarcilina/uso terapéutico , Resultado del Tratamiento , Estados UnidosRESUMEN
OBJECTIVE: To measure the cost and effectiveness of 3 established antimicrobial regimens for the prevention of infective complications after abdominal surgery. DESIGN: A prospective randomized trial was performed involving a total of 1070 patients undergoing abdominal surgery. SETTING AND PATIENTS: All patients having upper gastrointestinal tract, colorectal, appendiceal, or biliary surgery at a major teaching hospital in Melbourne, Australia, were considered for entry into the study. INTERVENTIONS: Patients were randomized prior to surgery to receive a single dose of cefotaxime sodium (1 g), ticarcillin plus clavulanic acid (3.1 g), or ceftriaxone sodium, (1 g). All drugs were given intravenously at the start of anesthesia. MAIN OUTCOME MEASURES: Rates of major wound infections, minor wound infections, other wound problems, and other infective complications. The acquisition and administrative costs of the drugs used and the costs of the infective complications were measured. RESULTS: A Total of 1070 patients were entered into the study. Major wound infections occurred in 21 patients (2.0%). Twenty-five patients (2.3%) developed a minor wound infection. Other infective complications developed in 107 patients. There were significantly fewer minor wound infections in the ceftriaxone-treated group as compared with the other 2 groups. There was no differences in the frequency of major wound infections, other wound problems, or other infective complications. The acquisition costs of cefotaxime and ticarcillin plus clavulanic acid were less than those of ceftriaxone. The estimated cost of treating the infective complications in the group of patients who received ticarcillin plus clavulanic acid ($128,039) was greater than the cost associated with the groups being treated with cefotaxime ($91,243) or ceftriaxone ($96,095). CONCLUSIONS: The study indicates that each of the 3 regimens was associated with highly satisfactory control of postoperative infective complications after abdominal surgery. On the basis of the estimated costs of infective complications, cefotaxime and ceftriaxone appear equally effective for the prevention of infective complications after abdominal surgery. Acquisition costs for cefotaxime were lower and it is recommended as the preferred agent on this basis.