TREATMENT OF MODERATE-TO-SEVERE PNEUMONIA IN ELDERLY, LONG-TERM-CARE FACILITY RESIDENTS

Elderly residents of long-term care facilities who are moderately or s everely ill with pneumonia were enrolled into a prospective randomized comparison of intravenous ceftriaxone 1 g daily and intravenous ampic illin 1 g every 8 hours. In the intent-to-treat analysis, 14 (70%) of 20 patients randomized to ampicillin and 16 (94%) of 17 randomized to ceftriaxone were cured with initial empiric therapy (P =.07). Three pa tients (8.1%) died. Adverse events and deaths were similar for the two regimens. Initial empiric therapy with ampicillin was less costly per case (Canadian $196.30) then with ceftriaxone (C$221.84), but additio nal therapy required for patients randomized not cured with initial em piric ampicillin therapy increased the cost per case of this regimen ( C$284.08). Thus, empiric therapy with a broad-spectrum cephalosporin m ay be more effective than ampicillin in elderly patients in nursing ho mes who require parenteral therapy for pneumonia. The cost per case tr eated was less for empiric ceftriaxone than ampicillin, despite the hi gher I antimicrobial acquisition costs.