PHARMACOECONOMIC BENEFIT OF ANTIBIOTIC STEP-DOWN THERAPY - CONVERTINGPATIENTS FROM INTRAVENOUS CEFTRIAXONE TO ORAL CEFPODOXIME PROXETIL

OBJECTIVE: To evaluate the economic benefit associated with the early conversion of therapy from intravenous ceftriaxone to the comparable o ral third-generation cephalosporin, cefpodoxime proxetil. DESIGN: Open -label, unblind, nonrandomized clinical trial. SETTING: A 360-bed Vete rans Affairs Medical Center. PATIENTS: Forty patients who began receiv ing intravenous ceftriaxone for either a community-acquired pneumonia or a complicated urinary tract infection. INTERVENTION: Twenty patient s were selected, based on clinical assessment, to be converted from in travenous ceftriaxone to oral cefpodoxime proxetil. Twenty other compa rable patients, who would have been appropriate for step-down therapy, did not receive pharmacy intervention and were used as a control grou p. MEASUREMENTS: Both groups were assessed and compared for length of ceftriaxone therapy, length of oral follow-up therapy (if any), length of hospitalization, results of culture and sensitivity testing, treat ment success and readmissions, and cost of respective therapeutic regi mens. RESULTS: In the cefpodoxime study group, the average time receiv ing intravenous and oral antibiotics was 9.1 days at a total cost of $ 3040.26 for the 20 patients. In the control group, the average time re ceiving intravenous and oral antibiotics was 11.9 days at a total cost of $3961.26. A savings of $46.05 per patient was achieved. Patients r eceiving step-down therapy averaged 1 fewer day of hospitalization. CO NCLUSIONS: Pharmacist intervention and cefpodoxime step-down therapy w ere associated with decreased overall antibiotic costs in our intraven ous-to-oral program.