Jr. Hendrickson et Ds. North, PHARMACOECONOMIC BENEFIT OF ANTIBIOTIC STEP-DOWN THERAPY - CONVERTINGPATIENTS FROM INTRAVENOUS CEFTRIAXONE TO ORAL CEFPODOXIME PROXETIL, The Annals of pharmacotherapy, 29(6), 1995, pp. 561-565
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.