DRUG UTILIZATION REVIEW (DUR) OF THE 3RD-GENERATION CEPHALOSPORINS - FOCUS ON CEFTRIAXONE, CEFTAZIDIME AND CEFOTAXIME

Six parenteral third generation cephalosporins have been introduced in to clinical use in the past 10 years. The 3 most frequently available agents are cefotaxime, ceftriaxone and ceftazidime. These 3 third gene ration cephalosporins are characterised by a broad spectrum of activit y and increased stability to beta-lactamases compared with the first a nd second generation cephalosporins. However, there are growing number s of reports of resistance to these agents with increasing use. The ma jor differences in the properties of the 3 agents are the long half-li fe of ceftriaxone and its dual route of elimination. Ceftazidime is be st restricted to Pseudomonas aeruginosa infections where other agents are contraindicated or ineffective. Cefotaxime and ceftriaxone can be used in nosocomial Gram-negative infections where P. aeruginosa can be ruled out. The types and incidences of adverse drug reactions are not different for the 3 agents. A number of drug utilisation review (DUR) studies of these agents in the hospital setting have reported a consi derable incidence of inappropriate use and substantial avoidable costs . There are methodological problems with most of the DUR studies, espe cially the criteria and the methods of cost estimation. The use of pha rmacoeconomic methodology could ensure more realistic cost estimation; however, outcome data are, in most cases, not available.