Determinants, outcomes and costs of ceftriaxone v. amoxicillin-clavulanate in the treatment of community-acquired pneumonia at Witbank Hospital.

BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of death and morbidity worldwide. Treatment is centred on antibiotics with ceftriaxone and amoxicillin-clavulanate being some of the most commonly prescribed agents. OBJECTIVE: To compare treatment outcomes and costs in patients receiving either of these two antibiotics at Witbank Hospital (WH). METHODS: A total of 200 randomly selected adult patient files (100 receiving ceftriaxone and 100 amoxicillin-clavulanate) recording a diagnosis of CAP were studied to determine the length of hospital stay, comorbid conditions and treatment outcomes. A descriptive and comparable analysis was performed. RESULTS: Male gender, higher CURB-65 scores and death were associated with the use of ceftriaxone. Severity of disease and previous antibiotic exposure influenced the duration of hospital admission. CONCLUSION: Gender and severity of disease (based on the CURB-65 score) were the determinants of antibiotic choice at WH. Male gender increased the likelihood of being treated with ceftriaxone, as did a CURB-65 score of > 2. There were no differences in the outcomes of CAP patients treated with ceftriaxone compared with those treated with amoxicillin-clavulanate. Irrespective of antibiotic used, gender and severity of disease influenced treatment outcomes. Male gender was associated with a higher mortality and longer hospital stay. The average duration of stay for both antibiotics was not significantly different. Thus, only level 1 and 2 costs need to be considered when comparing the two regimens. On this basis, ceftriaxone was cheaper than amoxicillin-clavulanate.

Estimation of the clinical and economic consequences of non-compliance with antimicrobial treatment of canine skin infections.

The goal of this study was to estimate the health and economic consequences of non-compliance with oral antimicrobial treatment in dogs with superficial pyoderma, wounds or abscesses in the US. A mathematical model (Markov model) which simulated treatment with long-term injectable cefovecin versus oral amoxicillin/clavulanic acid was developed and accounted for the effect of non-compliance on clinical outcomes and mean total treatment costs per patient. Efficacy parameters considered in the model were derived from clinical studies. Treatment failure due to oral antimicrobial treatment non-compliance was approximated from published data at 13.6%. US cost data for 2009 were derived from public sources. When non-compliance was considered as a cause of treatment failure with oral medication, the long-term injectable antibiotic was more effective than oral comparator (162 versus 158 days without clinical signs). Mean total treatment costs were lower with cefovecin (USD 376.74) versus amoxicillin/clavulanic acid (USD 382.34) in dogs of 25 kg; and cefovecin remained cost-saving up to a body weight of 31 kg. In large dogs, cefovecin was more costly; however, total therapy costs were less than 6% greater than with amoxicillin/clavulanic acid. Accordingly the higher drug and administration costs of the long-term injectable antibiotic were totally or substantially offset when non-compliance was considered as reason for treatment failure with oral medication. The model also allowed for the estimation of the impact of various non-compliance scenarios.

A naturalistic comparison of amoxicillin/clavulanate extended release versus immediate release in the treatment of acute bacterial sinusitis in adults: A retrospective data analysis.

BACKGROUND: Choosing the most effective treatment for acute bacterial sinusitis (ABS) is helpful to avoid treatment failure. To date, studies comparing antibiotic options for ABS have compared amoxicillin/clavulanate (AMX/CA) immediate release (IR) versus other antibiotics, but have not included AMX/CA extended release (XR). OBJECTIVE: The purpose of this study was to determine whether the clinical advantages of AMX/CA XR found in a clinical trial setting translate to a naturalistic setting, relative to AMX/CA IR. METHODS: Data for this retrospective analysis were obtained from a managed care benchmark database that included >25 million patients from >30 health plans covering 7 US census divisions. Data from all patients aged > or =18 years with an index diagnosis of ABS between July 1, 2001, and December 31, 2003, were included. Episodes of ABS were classified as treatment successes (no additional prescriptions for antibiotics, ABS-related emergency department [ED] visits, or ABS-related inpatient hospitalizations within 30 days after the index prescription) or failures (> or =1 subsequent antibiotic prescription, an ABS-related ED visit, or an ABS-related inpatient hospitalization within 30 days after the index prescription). Treatment failures were subclassified as early or late. Mean costs were assessed for medical claims linked with a primary diagnosis of ABS and antibiotic pharmacy claims within the follow-up time period (through February 28, 2004). Descriptive statistics for demographic characteristics, utilization patterns, and success rates were calculated for each cohort. A multivariate general linear regression model was developed to assess differences in costs between the 2 cohorts. RESULTS: : Of the patients with an index antibiotic prescription filled within 3 days of ABS diagnosis (n = 241,511), a total of 3224 in the AMX/CA XR cohort (mean [SD] age, 41.8 [11.6] years; women, 57.7%) and 23,638 in the AMX/CA IR cohort (mean [SD] age, 41.9 [11.6] years; women, 62.7%) were included in the analysis. The rate of treatment success in patients treated with AMX/CA XR was 82.8% versus 81.0% in patients treated with AMX/CA IR (P < 0.015). Treatment success costs were significantly lower than treatment failure costs regardless of an early or late designation and ranged from 98 dollars to 110 dollars per episode (P < 0.001). After adjustment for background covariates, the mean cost of treating an episode of ABS was significantly lower for patients receiving AMX/CA XR versus those receiving AMX/CA IR (166.32 dollars vs 177.34 dollars [US 2004 dollars]; P < 0.001), representing a mean cost savings of 11.02 dollars per patient treated with AMX/CA XR over AMX/CA IR for ABS, regardless of treatment outcome. CONCLUSIONS: The results from this data analysis suggest that AMX/CA XR had significantly higher treatment success in ABS relative to AMX/CA IR in this naturalistic setting. AMX/CA XR was associated with significantly decreased total ABS-related costs in these adults.

Economic evaluation of the antibiotic treatment of exacerbations of chronic bronchitis and COPD in primary care.

This was an observational and economic survey performed in primary care practices throughout Spain to assess the effectiveness and direct medical costs derived from antibiotic treatment of exacerbations of chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD) in primary care. A total of 252 physicians included 1456 valid patients, 80% were male and the mean age was 68.2 years (SD = 9.8). The antibiotic treatment administered was moxifloxacin in 575 (39.5%), amoxicillin/clavulanate in 460 (31.6%) and clarithromycin in 421 (28.9%). No significant differences were found in clinical and demographic characteristics between treatment arms. The 30-days follow-up visit was completed by 1097 (75%) patients, who were therefore valid for economic evaluation. During follow-up, 440 new medical visits were generated, 69 patients required attendance in emergency wards (6.3%) and 22 were hospitalised (2%). The overall mean cost of exacerbation was Euro 118.58 [95% confidence interval (CI) = Euro 92.2-144.9] and Euro 52.44 (44.2%) were due to therapeutical failure. The mean cost of exacerbation was Euro 111.46 (95% CI = Euro 73.4-149.5) for patients treated with moxifloxacin, Euro 109.45 (95% CI = Euro 68.2-150.7) for those treated with amoxicillin/clavulanic acid and Euro 138.95 (95% CI = Euro 89.4-188.5) for patients receiving clarithromycin. In conclusion, a significant number of patients require new medical interventions after ambulatory treatment of exacerbations of CB or COPD. The mean cost of an exacerbation was Euro 118.58 and failure was responsible for 44.2% of the total cost of exacerbation.

Cefepime versus ticarcillin and clavulanate potassium and aztreonam for febrile neutropenia therapy in high-dose chemotherapy patients.

An open labeled randomized trial comparing the efficacy and cost of empirically applied cefepime (C) as monotherapy versus combination therapy consisting of ticarcillin and clavulanate potassium and aztreonam (T/A) was performed in febrile neutropenic patients following high-dose chemotherapy (HDC) +/- radiation, with or without peripheral blood stem cell support. Over a 28-month period, 126 patients were screened and included in the study. Using afebrile status following 3 days of therapy as a primary endpoint, both regimens produced comparable clinical response rates (C = 55% vs. T/A = 61%). Also, the use of vancomycin for resistant gram-positive infections and alteration of gram-negative infection coverage was similar in both groups (C = 40% vs. T/A = 47% and C = 29% vs. T/A = 24%). Both treatment groups had similar needs for empirical antifungal therapy (C = 25% vs. T/A = 22%). There was a postrandomization difference between the two groups in that the "C" group had a significantly higher number of allogeneic transplants and non-stem-cell-supported patients, whereas the "T/A" group had a significantly greater number of autologous peripheral blood stem cell patients (p < 0.0001). Despite this difference, the C group had a significantly lower cost ratio than the T/A group (p = 0.016). In conclusion, we have shown that C treatment of febrile neutropenic patients following HDC results in similar efficacy and lower cost when compared to T/A, despite the inclusion of higher risk patients in the C group.