Once-daily cefepime versus ceftriaxone for nursing home-acquired pneumonia.
OBJECTIVE
To compare once-daily intramuscular cefepime with ceftriaxone controls.


METHODS
Double-blind study.


METHODS
Six skilled nursing facilities.


METHODS
Residents aged 60 and older with nursing home-acquired pneumonia.


METHODS
Cultures were obtained, and patients were randomized to cefepime or ceftriaxone 1 g intramuscularly every 24 hours.


METHODS
Clinical success: cure or improvement. Cure was defined as complete resolution of all symptoms and signs of pneumonia or a return to the patient's baseline state. Improvement was defined as clear improvement but incomplete resolution of all pretherapy symptoms or signs or incomplete return to the patient's usual baseline status. Safety and pharmacoeconomics were also assessed.


RESULTS
Sixty-nine patients were randomized; 61 were evaluable: (32 to cefepime, 29 ceftriaxone). Patients were predominately female (76%). They had a mean age+/-standard deviation of 85+/-6, with a mean 5.8+/-1.9 comorbidities; they had age-appropriate renal dysfunction, with a mean estimated creatinine clearance of 35+/-7 mL/min. Clinical success occurred in 78% of cefepime- and 66% of ceftriaxone-treated patients (P=.39). Fifty-seven patients (93%) were switched to oral antibiotics after 3 days. Antibiotic-related adverse events occurred in 5% of patients. Seven patients (11.5%) were hospitalized. The overall mortality rate was 8%. Mean antibiotic costs were 117+/-40 dollars for cefepime- and 215+/-68 dollars for ceftriaxone-treated patients (P<.001). Cost-effectiveness analysis of total costs showed that cefepime would cost 597 dollars and ceftriaxone 1,709 dollars per expected successfully treated patient. One- and two-way sensitivity analyses using a generic price for ceftriaxone and improving its comparative efficacy revealed that the results were robust.


CONCLUSIONS
Once-daily cefepime was a cost-effective alternative to ceftriaxone for the treatment of elderly nursing home residents who developed pneumonia and did not require hospitalization.
Paladino
Joseph A
JA
CPL Associates, LLC, Amherst, Buffalo, NY 14226, USA. paladino@cplassociates.com
Eubanks
David A
DA
Adelman
Martin H
MH
Schentag
Jerome J
JJ
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000493:pharmacokinetics; D000077723:Cefepime; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000191:economics / Q000493:pharmacokinetics; D002511:Cephalosporins / Q000008:administration & dosage* / Q000191:economics / Q000493:pharmacokinetics; D003428:Cross Infection / Q000188:drug therapy*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002443:Ceftriaxone; D000077723:Cefepime