title: Cost-minimization analysis and audit of antibiotic management of bone and joint infections with ambulatory teicoplanin, in-patient care or outpatient oral linezolid therapy.
abstract: Bone and joint infections are significant causes of morbidity, mortality and healthcare costs. The cost of treatment for such infections is driven primarily by the length of hospital stay. Many of these infections will require treatment with prolonged periods of parenteral antibiotic therapy. Clinicians and healthcare managers are being attracted increasingly by administering treatment in the ambulatory setting as this offers clinical, economic and quality of life advantages from both the hospital's and patient's perspective. Our retrospective audit of managing 55 treatment episodes of bone and joint infections with teicoplanin delivered in the outpatient or home setting revealed that the mean cost of care per episode of infection was less with treatment in the ambulatory setting ( pound 1749.15) compared with the in-patient setting ( pound 11 400) or compared with the hypothetical situation of treatment with oral linezolid in the home setting ( pound 2546). Teicoplanin therapeutic drug monitoring appears to be valuable in establishing optimal serum levels, which appear to correlate with good clinical outcomes. The potential for alternative day or thrice weekly dosing with teicoplanin may offer further cost advantages whilst maintaining equivalent clinical effectiveness.
authors.affiliation: Infection and Immunodeficiency Unit, Ward 42, East Block, UK. dilip.nathwani@tuht.scot.nhs.uk
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Barlow
authors.forename: Katherine
authors.initials: K
authors.lastname: Ajdukiewicz
authors.forename: Kirsteen
authors.initials: K
authors.lastname: Gray
authors.forename: John
authors.initials: J
authors.lastname: Morrison
authors.forename: Ben
authors.initials: B
authors.lastname: Clift
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: France
authors.forename: Peter
authors.initials: P
authors.lastname: Davey
mesh_terms: D000081:Acetamides / Q000191:economics* / Q000627:therapeutic use*; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use*; D001850:Bone Diseases, Infectious / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D002985:Clinical Protocols; D003363:Cost Control; D003365:Costs and Cost Analysis; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology; D000069349:Linezolid; D023303:Oxazolidinones / Q000191:economics* / Q000627:therapeutic use*; D012293:Rifampin / Q000191:economics / Q000627:therapeutic use; D017334:Teicoplanin / Q000191:economics* / Q000627:therapeutic use*; D006113:United Kingdom
chemical_list: D000081:Acetamides; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D017334:Teicoplanin; D000069349:Linezolid; D012293:Rifampin