Comparison of cefoxitin and ceftizoxime in a hospital therapeutic interchange program.
OBJECTIVE
To determine whether (a) ceftizoxime can replace cefoxitin in the prevention and treatment of various infections in a major teaching hospital, (b) a previously applied two-stage intervention program is an effective method of instituting a therapeutic interchange of ceftizoxime for cefoxitin and (c) the replacement of cefoxitin with ceftizoxime results in a more cost-effective therapy.


METHODS
Two-phase, open, sequential study.


METHODS
Tertiary care teaching hospital.


METHODS
One hundred patients who received cefoxitin during the 6 months immediately before the start of the interchange program (phase 1) and 100 who received ceftizoxime during the 6 months immediately after the start of the program (phase 2) were randomly selected.


RESULTS
The demographic characteristics of the two patient groups were similar except for sex (p < 0.05). The cefoxitin doses were usually given every 6 hours (in 33% of the cases) or every 8 hours (in 61%), whereas the ceftizoxime doses were usually given every 12 hours (in 98%). Prescriber distribution was stable throughout the study period, the Department of General Surgery being responsible for about 70% of the orders. Prophylactic indications accounted for over 60% of the treatment courses. The proportion of prophylactic treatment courses that resulted in a successful clinical outcome did not differ between the two groups (cefoxitin 92% and ceftizoxime 91%). Of the empiric or directed treatment courses clinical success or improvement was observed in 89% of the cefoxitin and 91% of the ceftizoxime recipients. Microbiologic eradication was seen in 65% of the cefoxitin and 90% of the ceftizoxime directed treatment courses. Pathogens isolated during therapy were similar in the two treatment groups. Diarrhea was the most common adverse effect, occurring in 8% of the cefoxitin and 10% of the ceftizoxime recipients; no Clostridium difficile or C.-difficile-producing toxin was identified in these patients. The ceftizoxime therapy was 36% less expensive than the cefoxitin therapy on average, and the annual savings was estimated to be $83,123. An estimated 5615 drug doses were avoided annually, for an additional savings of $24,875 in drug administration. Therefore, the total estimated annual cost savings resulting from this two-stage interchange program was $107,998. Given the cost of $4856 to implement and maintain the program, the estimated net savings for the first year was $103,142.


CONCLUSIONS
Ceftizoxime can replace cefoxitin in the prevention and treatment of various infections. The form of evaluation described herein is valuable when any formulary modification is being considered in a hospital.
Martinusen
S
S
Department of Pharmacy, Vancouver General Hospital, BC.
Chen
D
D
Frighetto
L
L
Bunz
D
D
Stiver
H G
HG
Jewesson
P J
PJ
D000328:Adult; D000368:Aged; D001955:British Columbia; D002440:Cefoxitin / Q000191:economics* / Q000627:therapeutic use*; D015296:Ceftizoxime / Q000191:economics* / Q000627:therapeutic use*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005572:Formularies, Hospital as Topic; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D002440:Cefoxitin; D015296:Ceftizoxime