Cost-Effectiveness of Ceftazidime By Continuous Infusion
Cost-Effectiveness of Ceftazidime By Continuous Infusion
Study Objective. To determine if continuous-infusion ceftazidime is more cost-effective and efficacious than intermittent infusion in patients with nosocomial pneumonia.
Design. Prospective, open-label, randomized trial.
Setting. Large, community teaching hospital.
Patients. Intensive care unit (ICU) patients with nosocomial pneumonia.
Interventions. Ceftazidime 3 g/day was administered as a continuous infusion or as 2 g 3 times/day by intermittent infusion to treat nosocomial pneumonia in the ICU. Patients also received tobramycin 7 mg/kg once/day.
Measurements and Main Results. Thirty-five patients were evaluable; 17 received continuous infusion and 18 intermittent infusion. Clinical efficacy (94% and 83% successful outcomes with continuous and intermittent infusion, respectively), adverse events, and length of stay did not vary significantly between groups. Costs associated with continuous infusion, $627 ± 388, were significantly lower (p <0.001) than with intermittent infusion, $1007 ± 430.
Conclusions. Continuous infusion of ceftazidime is a cost-effective alternative to intermittent infusion for nosocomial pneumonia in the ICU.
Among nosocomial infections, pneumonia ranks second in frequency but first in morbidity and mortality. Although severity of underlying clinical condition primarily determines outcome, nosocomial pneumonia in and of itself contributes to patient mortality in the intensive care unit (ICU). Moreover, nosocomial pneumonia greatly increases costs, extending hospital stay by 7-9 days/patient.
The focus of patient outcome studies is to achieve the best possible clinical outcome at the lowest cost. Often, clinicians base decisions about treatment of nosocomial pneumonia entirely on the microbiologic activity of antibiotics. This may lead to suboptimal therapy, since it is the combination of pharmacokinetics and microbiologic activity (pharmacodynamics) that determines an antibiotic's activity in vivo.
Because of reliable activity against typical hospital-acquired pathogens and favorable toxicity profiles, broad-spectrum cephalosporins often are chosen by clinicians as sole therapy or part of a regimen to treat nosocomial pneumonia. ß-lactam antibiotics exhibit concentration-independent bactericidal activity; specifically, concentrations over 2-4 times the minimum inhibitory concentration (MIC) contribute very little to eradication of bacteria. The primary determinant of ß-lactam efficacy is the duration of time that concentrations remain above the MIC. One way to optimize the pharmaco-dynamic profile of time-dependent drugs such as ß-lactams is administration by continuous infusion. Although these antibiotics traditionally have been given by intermittent infusion, continuous infusion is gaining popularity because it takes full advantage of known antibiotic pharmacodynamics. Continuous infusion is a practical way to maintain 100% time above the MIC with less total daily drug administered (e.g., ceftazidime 3 g/day by continuous infusion vs 1-2 g/day by intermittent infusion).
Limited data exist on either clinical efficacy or cost-effectiveness of ß-lactam administration by continuous infusion. Although several antibiotic regimens are appropriate for empiric treatment of nosocomial pneumonia, the challenge in the current economic environment is to find a clinically proven, cost-effective regimen. Ceftazidime, a broad-spectrum cephalosporin, is a common antimicrobial agent used in the treatment of nosocomial infections. Based on its pharmacodynamics, ceftazidime by continuous infusion should be more cost-effective than standard intermittent dosing. We therefore conducted an open-label, prospective, randomized trial was to assess the clinical outcome and pharmacoeconomics of ceftazidime by continuous or intermittent infusion plus tobramycin once/day for the treatment of nosocomial pneumonia.
Study Objective. To determine if continuous-infusion ceftazidime is more cost-effective and efficacious than intermittent infusion in patients with nosocomial pneumonia.
Design. Prospective, open-label, randomized trial.
Setting. Large, community teaching hospital.
Patients. Intensive care unit (ICU) patients with nosocomial pneumonia.
Interventions. Ceftazidime 3 g/day was administered as a continuous infusion or as 2 g 3 times/day by intermittent infusion to treat nosocomial pneumonia in the ICU. Patients also received tobramycin 7 mg/kg once/day.
Measurements and Main Results. Thirty-five patients were evaluable; 17 received continuous infusion and 18 intermittent infusion. Clinical efficacy (94% and 83% successful outcomes with continuous and intermittent infusion, respectively), adverse events, and length of stay did not vary significantly between groups. Costs associated with continuous infusion, $627 ± 388, were significantly lower (p <0.001) than with intermittent infusion, $1007 ± 430.
Conclusions. Continuous infusion of ceftazidime is a cost-effective alternative to intermittent infusion for nosocomial pneumonia in the ICU.
Among nosocomial infections, pneumonia ranks second in frequency but first in morbidity and mortality. Although severity of underlying clinical condition primarily determines outcome, nosocomial pneumonia in and of itself contributes to patient mortality in the intensive care unit (ICU). Moreover, nosocomial pneumonia greatly increases costs, extending hospital stay by 7-9 days/patient.
The focus of patient outcome studies is to achieve the best possible clinical outcome at the lowest cost. Often, clinicians base decisions about treatment of nosocomial pneumonia entirely on the microbiologic activity of antibiotics. This may lead to suboptimal therapy, since it is the combination of pharmacokinetics and microbiologic activity (pharmacodynamics) that determines an antibiotic's activity in vivo.
Because of reliable activity against typical hospital-acquired pathogens and favorable toxicity profiles, broad-spectrum cephalosporins often are chosen by clinicians as sole therapy or part of a regimen to treat nosocomial pneumonia. ß-lactam antibiotics exhibit concentration-independent bactericidal activity; specifically, concentrations over 2-4 times the minimum inhibitory concentration (MIC) contribute very little to eradication of bacteria. The primary determinant of ß-lactam efficacy is the duration of time that concentrations remain above the MIC. One way to optimize the pharmaco-dynamic profile of time-dependent drugs such as ß-lactams is administration by continuous infusion. Although these antibiotics traditionally have been given by intermittent infusion, continuous infusion is gaining popularity because it takes full advantage of known antibiotic pharmacodynamics. Continuous infusion is a practical way to maintain 100% time above the MIC with less total daily drug administered (e.g., ceftazidime 3 g/day by continuous infusion vs 1-2 g/day by intermittent infusion).
Limited data exist on either clinical efficacy or cost-effectiveness of ß-lactam administration by continuous infusion. Although several antibiotic regimens are appropriate for empiric treatment of nosocomial pneumonia, the challenge in the current economic environment is to find a clinically proven, cost-effective regimen. Ceftazidime, a broad-spectrum cephalosporin, is a common antimicrobial agent used in the treatment of nosocomial infections. Based on its pharmacodynamics, ceftazidime by continuous infusion should be more cost-effective than standard intermittent dosing. We therefore conducted an open-label, prospective, randomized trial was to assess the clinical outcome and pharmacoeconomics of ceftazidime by continuous or intermittent infusion plus tobramycin once/day for the treatment of nosocomial pneumonia.
