Sc. Malfair et al., EVALUATION OF THE USE OF CEFUROXIME AND CEFUROXIME AXETIL IN AN INTRAVENOUS ORAL STEPDOWN PROGRAM, The Annals of pharmacotherapy, 30(4), 1996, pp. 337-342
OBJECTIVE: To characterize cefuroxime and cefuroxime axetil use under
the influence of a parenteral-to-oral (iv-po) stepdown program. DESIGN
: Open single-center retrospective review. SETTING: Tertiary care teac
hing and referral Canadian hospital with 1100 beds.PATIENTS: A random
sample of 78 patients receiving cefuroxime was compared with a random
sample of 50 patients receiving iv-po cefuroxime stepdown. RESULTS: Du
ring the first 6 months following formulary introduction, 1535 patient
s received cefuroxime. Stepdown to any oral antibiotic occurred in 22%
of patients. Cefuroxime axetil was used as the stepdown agent in 64%
of these cases. In a comparison of nonstepdown courses with stepdown c
ourses, some differences were apparent. Nonstepdown treatment courses
were primarily prophylactic, whereas stepdown courses were typically i
nitiated as primary therapy for the 10-day management of respiratory t
ract infections (p < 0.001). Conversion to oral therapy typically occu
rred on day 5 of parenteral therapy and continued for 5 days. Stepdown
was considered possible in 45% of treatment courses in which this pro
cess did not happen. When stepdown did occur, it was considered timely
in 64% of cases, unnecessarily delayed in 32%, and premature in 4% of
treatment courses. Stepdown did not appear to be associated with a ne
gative impact on patient outcome. Mean I SD cost of drug therapy per d
ay was less for the stepdown group (US $15.78 +/- $5.97) than the nons
tepdown group (US $25.47 +/- $7.87; p < 0.001). CONCLUSIONS: As a resu
lt of this study we intend to maintain cefuroxime and cefuroxime axeti
l on the formulary and continue to judiciously promote the timely conv
ersion to oral therapy.