EVALUATION OF THE USE OF CEFUROXIME AND CEFUROXIME AXETIL IN AN INTRAVENOUS ORAL STEPDOWN PROGRAM

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.