Clinical efficacy and pharmacoeconomics of a continuous-infusion piperacillin-tazobactam program in a large community teaching hospital.
OBJECTIVE
To compare continuous versus intermittent administration of piperacillin-tazobactam with regard to clinical, microbiologic, and economic outcomes.


METHODS
Prospective, open-label controlled study


METHODS
Community teaching hospital.


METHODS
Ninety-eight hospitalized patients prescribed piperacillin-tazobactam.


METHODS
Substitutions were implemented so that 47 patients initially prescribed intermittent infusion of piperacillin-tazobactam were switched to continuous infusion of this drug combination. Dosages varied in accordance with the type of infection and each patient's renal function. Fifty-one other patients with similar demographics and types of infection received intermittent infusion with piperacillin-tazobactam.


RESULTS
Clinical success rates were 94% for the continuous-infusion group and 82% for the intermittent-infusion group (p=0.081). Microbiologic success rates were 89% for the continuous-infusion group and 73% for the intermittent-infusion group (p=0.092). Days to normalization of fever were significantly lower (p=0.012) in the continuous-infusion group (1.2 +/- 0.8 days) than in the intermittent-infusion group (2.4 +/- 1.5 days). Level 1 and level 2 costs/patient were both reduced by continuous infusion, although the difference was statistically significant only for level 2 costs ($399.38 +/- 407.22 for continuous infusion vs $523.49 +/- 526.85 for intermittent infusion, p=0.028).


CONCLUSIONS
Continuous infusion of piperacillin-tazobactam provided clinical and microbiologic outcomes equivalent to those for intermittent infusion. Compared with intermittent infusion, continuous infusion significantly shortened the time to temperature normalization, while also offering a significant reduction in level 2 expenditures.
Grant
Edward M
EM
Ortho-McNeil Pharmaceutical, Inc, Raritan, New Jersey, USA.
Kuti
Joseph L
JL
Nicolau
David P
DP
Nightingale
Charles
C
Quintiliani
Richard
R
D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics*; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D005260:Female; D006764:Hospitals, Community / Q000191:economics / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives / Q000191:economics*; D010878:Piperacillin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D000077725:Piperacillin, Tazobactam Drug Combination; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin