SEQUENTIAL PARENTERAL AND ORAL CIPROFLOXACIN REGIMEN VERSUS PARENTERAL THERAPY FOR BACTEREMIA - A PHARMACOECONOMIC ANALYSIS

OBJECTIVE: To compare, in patients with gram-negative bacteremia, a co urse of parenteral antibiotic therapy alone wit initial parenteral the rapy followed by oral ciprofloxacin in terms of the length of hospital ization, clinical effectiveness, toxicity, an cost. DESIGN: A prospect ive, controlled, randomized, open trial in select hospitalized patient s. SETTING: Large metropolitan teaching hospital. PATIENTS: Fifty hosp italized patients with proven gram-negative bacteremia were randomized to receive either oral ciprofloxacin (group 1) following a 72-hour in itial intravenous antibiotic regimen or to continue parenteral therapy alone (group 2). To compare the length of hospitalization, an additio nal group of 50 hospitalized patients with bacteremia (not enrolled in the study, group 3) were analyzed. INTERVENTION: Parenteral antibioti cs for 72 hours followed by continuation of a parenteral regimen or or al ciprofloxacin 750 mg bid. MAIN OUTCOME MEASURES: Clinical response, toxicity, and length of hospitalization. RESULTS: Clinical resolution was comparable in the 24 group 1 patients receiving intravenous antib iotics followed by oral ciprofloxacin (83%), the 26 group 2 patients r eceiving parenteral therapy alone (77%), and the 50 comparison patient s (76%). There was little toxicity noted in any group, and the initial parenteral antibiotic regimens were similar. The mean numbers of hosp ital days on antibiotics were 9.1, 11.2, and 10.6 days in groups 1 2, and 3, respectively (p<0.05 for group 1 vs. group 2 or 3), and the len gths of hospitalization were 9.8, 15.7, and 12.1 days, respectively (p <0.05 for group 1 vs. group 2 or 3). Shortening the length of hospital ization and days of antibiotic therapy was associated with a cost savi ngs of up to $78000 for group 1 patients. CONCLUSIONS: Parenteral ther apy for 72 hours followed by oral ciprofloxacin significantly shortene d both the number of hospital days taking antibiotics and the length o f stay compared with parenteral therapy alone. Both regimens were equa lly effective and safe in the therapy of gram-negative bacteremia, and initial parenteral therapy followed by oral ciprofloxacin was cost-ef fective.