The extended-spectrum penicillins: microbiologic, utilization, and cost review in a community hospital.
The extended-spectrum penicillins have a similar spectrum of activity and clinical efficacy. The newer acylaminopenicillins (azlocillin, mezlocillin, piperacillin) offer several potential therapeutic advantages over the carboxypenicillins (carbenicillin, ticarcillin), but they are more expensive per gram. Literature reviews of these penicillins suggest that individual hospital susceptibility patterns and cost should guide selection of the most appropriate antibiotic for formulary addition. Consequently, the authors performed a microbiologic, utilization, and cost review of these antibiotics in a community hospital. From this hospital and literature review, the authors were able to make the following conclusions: (1) the newer acylaminopenicillins exhibited similar activity against common clinical pathogens and were microbiologically more active than the carboxypenicillins; (2) none of these antibiotics used alone appears adequate for empiric treatment of serious systemic gram-negative bacillary infections; (3) the extended-spectrum penicillins were prescribed in a similar fashion and usually in conjunction with an aminoglycoside; and (4) significant cost savings can be realized when less expensive drugs are used. The authors found only minor differences in microbiologic activity and clinical use among the newer extended-spectrum penicillins. Therefore, they recommend the least expensive drug for routine use in the hospital.
D000667:Ampicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002228:Carbenicillin / Q000008:administration & dosage*; D003365:Costs and Cost Analysis; D004363:Drug Utilization / Q000191:economics*; D006744:Hospital Bed Capacity, 100 to 299; D006764:Hospitals, Community; D006801:Humans; D008824:Michigan