Antibiotic utilization and cost analysis in hospitalized patients with community-acquired pneumonia.
All cases of presumptive community-acquired pneumonia (CAP) in adult patients admitted to a community/teaching hospital during the first 6 months of 1993 were reviewed. A total of 67 patients ranging in age from 20-90 years (73% > 60 years) had CAP. Fifteen (22%) patients were receiving antibiotics before admission. A typical respiratory pathogen was identified in only 18 (27%) patients. Empiric parenteral antibiotics were initiated in all but 2 patients. These agents usually included cefuroxime (42%), ampicillin/sulbactam (28%), or ceftriaxone (14%). Concomitant erythromycin (25%) or clarithromycin (17%) was used empirically in 42% of patients. Parenteral antibiotics were given for a mean of 5.2 days (median, 4 days). The mean therapy cost of these common parenteral agents ranged from $69.50 (cefuroxime, 750 mg every 8 hours) to $271 (ceftriaxone, 1 gram every 12 hours). Hospitalization ranged from 2-37 days (mean, 8.3 days; median, 6 days). A total of 50 patients were switched to oral antibiotics. Prescriptions for outpatient therapy ranged from 5-21 days (mean, 8.6 days; median, 7 days). The most common oral antibiotics included cefuroxime (33%), clarithromycin (20%), and amoxicillin/clavulanate (20%). The mean therapy cost for these drugs ranged from $85.19 (cefuroxime, 500 mg every 12 hours) to $39.24 (clarithromycin, 500 mg every 12 hours). This study found that empiric therapy with low-dose parenteral cefuroxime, with or without erythromycin, followed by outpatient clarithromycin was less costly than other common regimens used to treat CAP.
Michigan State University, Department of Medicine, East Lansing 48824.
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D016527:Drug Costs; D017723:Drug Utilization Review / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007263:Infusions, Parenteral; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology