A clinical and economic study of community-acquired pneumonia between single versus combination therapy.
BACKGROUND
Pneumonia is one of the leading causes of morbidity and mortality among children in many developing countries. It is reported that 12.9 million children under 5 years of age died world-wide in 1990 and one-third of these deaths or 4.3 million annually were attributed to acute respiratory infection with pneumonia.


OBJECTIVE
On this basis, a study was conducted in a district hospital to study the therapy outcomes of antibiotic regimens used in pediatric community-acquired pneumonia (CAP) management and to conduct a cost-effectiveness analysis (CE) between IV ampicillin versus combination therapy of IV ampicillin and IV gentamicin.


METHODS
A prospective, randomized, controlled, single blind study was conducted in a pediatric ward in a 80-bed district hospital. Pediatric patients diagnosed with CAP aged 2 months to 5 years old were randomly and equally divided into two treatment arms: ampicillin versus ampicillin plus gentamicin. The dose of IV ampicillin used in this study was 100 mg/kg/day divided every 6 h and 5 mg/kg of IV gentamicin as a single daily dose. Both clinical and economic evaluations were carried out to compare both treatment arms.


RESULTS
With the inclusion and exclusion criteria, only 40 patients diagnosed with CAP were included in the study. The results showed that the two treatment arms were significantly different (P < 0.05) in terms of duration of patients on ampicillin, number of days of hospitalization and time to switch to oral therapy. A significant difference was noted between the two treatment modalities in terms of effectiveness and cost (P < 0.05).


CONCLUSIONS
Overall, the endpoint of this study showed that the total cost per patient of ampicillin-treated group is cheaper than the total cost with the combination therapy (ampicillin plus gentamicin) and reduced unnecessary exposure to adverse effects or toxicities. Besides that, addition of gentamicin in the treatment modalities will only increase the cost of treatment without introducing any changes in the treatment outcome.
Hasali
Mohamed Azmi Ahmad
MA
School of Pharmaceutical Sciences, universiti Sains Malaysia, 11800, Penang, Malaysia. mizham@usm.my
Ibrahim
Mohamed Izham Mohamed
MI
Sulaiman
Syed Azhar Syed
SA
Ahmad
Zhari
Z
Hasali
Jameela Banu Ahmad
JB
D000328:Adult; D000667:Ampicillin / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D003625:Data Collection; D003627:Data Interpretation, Statistical; D004311:Double-Blind Method; D005260:Female; D005839:Gentamicins / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008296:Malaysia; D008297:Male; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics*; D011446:Prospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000667:Ampicillin