CEFTAZIDIME DOSING IN THE ELDERLY - ECONOMIC-IMPLICATIONS

OBJECTIVE: This study evaluated the prevalence and resulting costs of ceftazidime dosing in excess of product labeling recommendations in el derly hospitalized patients. Ceftazidime is a beta-lactam antibiotic e xcreted via glomerular filtration. According to product labelling, cef tazidime dosing can frequently be decreased in the elderly because glo merular filtration declines with age. METHODOLOGY: A multicenter, retr ospective utilization audit involving 11 US academic medical centers e xamined 221 medical records of patients 65 years of age or older recei ving ceftazidime (any brand, any indication). The creatinine clearance of each patient was estimated using the Cockcroft-Gault formula. RESU LTS: Renal insufficiency, defined as an estimated creatinine clearance of less than 50 mL/min, was present in 111 of the patients (50 percen t). Ceftazidime dosing in excess of product labeling recommendations w as noted in 75 of those 111 (68 percent). The cost of excess ceftazidi me dosing for those 75 patients (i.e., extra drug acquisition, prepara tion, administration) was $13 822.50.. CONCLUSIONS: Although die dosag e of ceftazidime required in a specific patient is based on many facto rs, ceftazidime is frequently overdosed in the elderly because renal f unction is not considered. Ceftazidime dose-adjustment in the elderly, based on the estimated creatinine clearance, can lead to cost savings . In the US, where hospital reimbursement by Medicare is based on diag nosis, institutions can realize direct cost savings.