Sequential parenteral and oral ciprofloxacin regimen versus parenteral therapy for bacteremia: a pharmacoeconomic analysis.
OBJECTIVE
To compare, in patients with gram-negative bacteremia, a course of parenteral antibiotic therapy alone with initial parenteral therapy followed by oral ciprofloxacin in terms of the length of hospitalization, clinical effectiveness, toxicity, and cost.


METHODS
A prospective, controlled, randomized, open trial in select hospitalized patients.


METHODS
Large metropolitan teaching hospital.


METHODS
Fifty hospitalized patients with proven gram-negative bacteremia were randomized to receive either oral ciprofloxacin (group 1) following a 72-hour initial intravenous antibiotic regimen or to continue parenteral therapy alone (group 2). To compare the length of hospitalization, an additional group of 50 hospitalized patients with bacteremia (not enrolled in the study, group 3) were analyzed.


METHODS
Parenteral antibiotics for 72 hours followed by continuation of a parenteral regimen or oral ciprofloxacin 750 mg bid.


METHODS
Clinical response, toxicity, and length of hospitalization.


RESULTS
Clinical resolution was comparable in the 24 group 1 patients receiving intravenous antibiotics followed by oral ciprofloxacin (83%), the 26 group 2 patients receiving parenteral therapy alone (77%), and the 50 comparison patients (76%). There was little toxicity noted in any group, and the initial parenteral antibiotic regimens were similar. The mean numbers of hospital days on antibiotics were 9.1, 11.2, and 10.6 days in groups 1,2, and 3, respectively (p < 0.05 for group 1 vs. group 2 or 3), and the lengths of hospitalization were 9.8, 15.7, and 12.1 days, respectively (p < 0.05 for group 1 vs. group 2 or 3). Shortening the length of hospitalization and days of antibiotic therapy was associated with a cost savings of up to $78 000 for group 1 patients.


CONCLUSIONS
Parenteral therapy for 72 hours followed by oral ciprofloxacin significantly shortened both the number of hospital days taking antibiotics and the length of stay compared with parenteral therapy alone. Both regimens were equally effective and safe in the therapy of gram-negative bacteremia, and initial parenteral therapy followed by oral ciprofloxacin was cost-effective.
Amodio-Groton
M
M
Department of Pharmacy, Montefiore Medical Center, Bronx, NY, USA.
Madu
A
A
Madu
C N
CN
Briceland
L L
LL
Seligman
M
M
McMaster
P
P
Miller
M H
MH
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000890:Anti-Infective Agents; D002939:Ciprofloxacin