Continuous vs. intermittent infusion of cefuroxime for the treatment of community-acquired pneumonia

There is increasing interest in the clinical utility and pharmacoeconomic b enefits of continuous infusion (CI) therapy with beta-lactam antibiotics be cause this form of therapy may be as efficacious as and less costly than in termittent infusion (II) therapy. We investigated the efficacy, pharmacokin etics, and pharmacoeconomics of CI cefuroxime therapy in adult patients wit h a primary diagnosis of community-acquired pneumonia (CAP) who were admitt ed to a 800-bed community teaching hospital. Twenty-five patients with CAP who received 750 or 1500 mg of cefuroxime per day by CI were compared with 25 patients given 750 mg of cefuroxime three times daily by II. Clinical cu re or improvement at the end of the course of intravenous therapy and 30 da ys later occurred in 23/24 and 21/22 evaluable patients in the II and CI gr oups, respectively. Steady-state serum cefuroxime concentrations in CI pati ents were 13.25 +/- 6.29 mu g/mL. These concentrations are more than two to four times the MIC90 values of the bacterial pathogens typically associate d with CAP. The mean (+/- SD) total amount of intravenous drug used (II gro up, 8021 +/- 3444 mg; CI group, 5953 +/- 3210 mg; P = .04) and cost of the drug, labor, and supplies (II group, $83.85 +/- $34.82; CI group, $63.64 +/ - $30.95; P = .04) were less in the CI group. Duration of inpatient antimic robial therapy and length of hospital stay tended to be shorter in the CI g roup, by 14.7 and 11.6 hours, respectively (P = not significant).. The dura tion of outpatient oral therapy was longer in the CI group (P = .05). Conse quently, there was a tendency toward shorter duration of inpatient therapy and longer duration of outpatient therapy in the CI group. These data suppo rt CI cefuroxime therapy as a pharmacodynamically sound and pharmacoeconomi cally beneficial alternative to II therapy in the treatment of CAP. However , randomized controlled trials may be warranted to verify the equivalence o f efficacy between treatment regimens.