title: Evaluation of the use of cefuroxime and cefuroxime axetil in an intravenous-oral stepdown program.
abstract: OBJECTIVE
  To characterize cefuroxime and cefuroxime axetil use under the influence of a parenteral-to-oral (iv-po) stepdown program.
  
  
  METHODS
  Open single-center retrospective review.
  
  
  METHODS
  Tertiary care teaching and referral Canadian hospital with 1100 beds.
  
  
  METHODS
  A random sample of 78 patients receiving cefuroxime was compared with a random sample of 50 patients receiving iv-po cefuroxime stepdown.
  
  
  RESULTS
  During the first 6 months following formulary introduction, 1535 patients received cefuroxime. Stepdown to any oral antibiotic occurred in 22% of patients. Cefuroxime axetil was used as the stepdown agent in 64% of these cases. In a comparison of nonstepdown courses with stepdown courses, some differences were apparent. Nonstepdown treatment courses were primarily prophylactic, whereas stepdown courses were typically initiated as primary therapy for the 10-day management of respiratory tract infections (p < 0.001). Conversion to oral therapy typically occurred on day 5 of parenteral therapy and continued for 5 days. Stepdown was considered possible in 46% of treatment courses in which this process did not happen. When stepdown did occur, it was considered timely in 64% of cases, unnecessarily delayed in 32%, and premature in 4% of treatment courses. Stepdown did not appear to be associated with a negative impact on patient outcome. Mean +/- SD cost of drug therapy per day was less for the stepdown group (US $15.78 +/- $5.97) than the nonstepdown group (US $25.47 +/- $7.87; p < 0.001).
  
  
  CONCLUSIONS
  As a result of this study we intend to maintain cefuroxime and cefuroxime axetil on the formulary and continue to judiciously promote the timely conversion to oral therapy.
authors.affiliation: Department of Pharmacy, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada.
authors.forename: S C
authors.initials: SC
authors.lastname: Malfair
authors.forename: L
authors.initials: L
authors.lastname: Frighetto
authors.forename: D M
authors.initials: DM
authors.lastname: Nickoloff
authors.forename: S M
authors.initials: SM
authors.lastname: Martinusen
authors.forename: P J
authors.initials: PJ
authors.lastname: Jewesson
mesh_terms: D000284:Administration, Oral; D000368:Aged; D002444:Cefuroxime / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D002511:Cephalosporins; D002444:Cefuroxime; C040738:cefuroxime axetil