title: Outcome of a ceftriaxone/cefotaxime interchange programme in a major teaching hospital.
abstract: A two-stage intervention programme was performed to enable the effective substitution of ceftriaxone for cefotaxime in a teaching hospital with large numbers of transient prescribers. One hundred and sixteen patients with a variety of bacterial infections were randomized to an open, historical control comparative study to determine if ceftriaxone was an acceptable replacement for cefotaxime. For 6 months prior to the intervention, both cephalosporins were available on formulary. Following an initial informational stage, a therapeutic interchange programme was implemented to convert prescriptions for cefotaxime to ceftriaxone. Ceftriaxone and cefotaxime were equivalent in terms of microbiological and clinical efficacy and patient tolerance in 77 evaluable patients. No changes in prescriber service occurred after the changeover. Post-intervention treatment courses required a ceftriaxone/cefotaxime interchange in 28% of the cases. Ceftriaxone appeared to be a suitable and cost-effective alternative to cefotaxime in this hospital. The intervention programme successfully invoked the formulary change with minimal expense and prescriber opposition.
authors.affiliation: Department of Pharmacy, Vancouver General Hospital, B.C. Canada.
authors.forename: A
authors.initials: A
authors.lastname: Gutensohn
authors.forename: D
authors.initials: D
authors.lastname: Bunz
authors.forename: L
authors.initials: L
authors.lastname: Frighetto
authors.forename: P
authors.initials: P
authors.lastname: Jewesson
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000188:drug therapy*; D002439:Cefotaxime / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000191:economics; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D002443:Ceftriaxone; D002439:Cefotaxime