Experience with ceftazidime parenteral-to-parenteral dosage stepdown in the empiric treatment of febrile neutropenia

We assessed the clinical and economic impact of a new parenteral-to-parente ral stepdown program involving ceftazidime for the treatment of febrile neu tropenia. This was a two-phase (before and after), 12-month, single-center, prospective study with a historical control. Ninety-eight ceftazidime trea tment courses (47 preintervention, 51 postintervention) were administered f or management of febrile neutropenia in 85 adults with hematologic malignan cies. Multidisciplinary creation and promotion of parenteral-to-parenteral ceftazidime stepdown criteria were applied at the discretion of the health care team. Patient demographics between phases were similar. Only 2 (4%) tr eatment courses before the intervention involved parenteral-to-parenteral d osage stepdown, compared with 34 (67%) after the intervention (p<0.00001). Mean number of total ceftazidime doses/treatment course and mean duration o f therapy did not change between phases. Clinical cure or improvement was i dentified in 74% and 80% of treatment courses before and after the interven tion, respectively. The two main reasons for discontinuing the drug before the intervention were recovery of neutrophil count (60%) and adverse reacti ons (19%). Neutrophil count recovery (59%) and hospital discharge (14%) wer e the two most common reasons for discontinuation after the intervention. O f 34 stepdown treatment courses after the intervention, 3 (9%) failed to me et established stepdown criteria, and 2 of these required stepdown reversal . Ancillary antibacterial drugs and treatment course outcomes were similar between phases. Total ceftazidime acquisition cost for 704 treatment days i n the preintervention phase was $52,473 CAN compared with $54,778 CAN for 9 07 days of therapy in the postintervention phase. The mean acquisition cost /ceftazidime treatment course was $1100 CAN and did not differ between phas es. The mean daily cost of ceftazidime therapy was lower after the interven tion ($60.39 vs $74.54 CAN) as a result of a greater frequency of stepdown (p<0.001). Assuming an equivalent number of treatment days, the projected a nnual acquisition cost avoidance associated with this stepdown program was $19,900 CAN.