[Cost-effectiveness analysis of ceftriaxone and cefotaxime in the treatment of community-acquired pneumonia]. / Estudio de costo-efectividad de ceftriaxona y cefotaxima en el tratamiento de neumonía adquirida en la comunidad.

OBJECTIVE: To assess the cost-effectiveness ratio of ceftriaxone and cefotaxime to treat moderate to severe community acquired pneumonia (CAP). METHODS: A clinical trial was done in five hospitals of the Instituto Mexicano del Seguro Social, at the metropolitan area of Mexico City. Ceftriaxone and cefotaxime were compared to treat moderate to severe CAP, and the costs of purchasing, preparation, administration, hospitalization, and therapeutic success were quantified. Cost-effectiveness ratio was calculated, and sensitivity analysis and incremental analysis were done. RESULTS: The main isolated germs were Streptococcus pneumoniae (23.6%) and Staphylococcus aureus (18.5%). Most of the microorganisms were sensitive to ceftriaxone, ceftazidime, and cefotaxime, and were resistant to penicillin, ampicillin, and erythromycin. Therapeutic success was 98% in the ceftriaxone group and 83% in the cefotaxime group (p = 0.0091). Cost-effectiveness ratio for per cent unit of success was $19,458.62 Mexican pesos in the ceftriaxone group and $29,218.08 in the cefotaxime group. Sensitivity analysis showed consistently a lower cost-effectiveness ratio in the ceftriaxone group. Incremental analysis based on the treatment of 55 patients showed that using ceftriaxone instead of cefotaxime resulted in saving $35,170.79 per each additional cured patient. CONCLUSIONS: Ceftriaxone has a lower cost-effectiveness ratio than cefotaxime to treat patients with CAP and bad prognosis criteria requiring hospitalization.

[Prospective, randomized, comparative study of the efficacy, safety and cost of cefuroxime versus cephradine in acute pyelonephritis during pregnancy]. / Estudio prospectivo, randomizado, comparativo de la eficacia, seguridad y costos de cefuroxima vs cefradina en la pielonefritis aguda del embarazo.

BACKGROUND: Second generation cephalosporins (CFPs) are more active in the treatment of acute pyelonephritis during pregnancy but their cost is considerably higher than their predecessors. Cefuroxime, a second generation CFP with oral and parenteral presentations, might offer significant advantages and become a first choice antimicrobial in this setting. AIM: To compare the efficacy, safety and cost of cefuroxime and cephradine in the treatment of acute pyelonephritis in pregnancy. PATIENTS AND METHODS: Hospitalized women with 12 to 34 weeks of pregnancy, with clinical and bacteriological diagnosis of acute pyelonephritis, were randomly assigned to receive cefuroxime (Curocef(r), Glaxo Wellcome) 750 mg t.i.d, i.v. or cephradine 1 g q.i.d., i.v. If the isolated organism was resistant to the assigned drug the patient was excluded. Once patients were afebrile, they were switched to an oral form of the same antimicrobial. They were discharged according to the clinical status and treated for a total of 14 days. laboratory tests, including urine culture were requested during controls and at the end of follow-up at 28 days. RESULTS: One hundred and one patients were randomized: 49 to receive cephradine and 52 to receive cefuroxime. Patients in the cefuroxime group hed fewer febrile days (mean 1.7 vs 2.2, p < 0.05), faster clinical recovery (mean 2.7 vs 3.1 days, p < 0.05), a higher rate of bacteriological cure at 28 days (78.8% and 59.2%, p < 0.05) and lower rate of failure (21.2% vs 40.8% p < 0.05). The rate of resistance of isolated uropathogens was 14% to cephradine and 1% to cefuroxime. CONCLUSIONS: Cefuroxime can be considered as a first choice option in the treatment of acute pyelonephritis during pregnancy due to its tolerance, microbiological activity and efficacy.

Comparison of ceftibuten vs. amoxicillin/clavulanic acid as antibiotic prophylaxis in cholecystectomy and/or biliary tract surgery.

A randomized, comparative, prospective clinical trial was carried out at a tertiary care center to compare the efficacy of two antibiotic regimens in the prophylaxis of postoperative infection in patients undergoing biliary tract surgery. One hundred patients undergoing cholecystectomy or biliary tract exploration were randomly allocated to one of the following antibiotic regimens: the standard regimen of three doses of amoxicillin/clavulanic acid (1000/200 mg) given by intravenous infusion, or a single dose of ceftibuten (400 mg) given orally. Patients were monitored during their stay in the hospital and over a 2 week period as outpatients. Fifty adult patients were included in each group. Mean age was 49 years, and sex distribution was 82 women and 18 men. The groups were comparable in terms of demographic characteristics and comorbidity. There were no cases of postoperative infection in the ceftibuten group, but five cases of infection occurred in the amoxicillin/clavulanic acid group (P < 0.05). No adverse effects were observed with either antibiotic. The treatment cost per patient was significantly lower for ceftibuten. The results indicate that ceftibuten is well tolerated and more effective than amoxicillin/clavulanic acid for prophylaxis following gallbladder and biliary tract surgery. In addition, ceftibuten has the advantage of being more cost-effective and easier to administer than amoxicillin/clavulanic acid so it could be considered as an alternative for antibiotic prophylaxis in these types of surgical procedures.

Cost analysis of antibiotic prophylaxis in clean head and neck surgery.

OBJECTIVE: This study was undertaken to assess the excess cost of hospitalization accrued to patients who develop postoperative wound infection following neck dissection in which the wound was not exposed to secretions from the upper aerodigestive tract. DESIGN: A retrospective cohort of patients who underwent "clean" neck dissection from 1976 to 1989 were evaluated. Antibiotic administration (yes or no), post-operative wound infection (yes or no), and duration and cost of hospitalization were assessed. SETTING: All surgeries were performed in a university medical center. PATIENTS: All patients underwent neck dissection in which the procedure was clean, ie, there was no exposure to secretions from the upper aerodigestive tract. MAIN OUTCOME MEASURES: Patients were assessed to determine administration of antibiotics (yes or no), development of postoperative wound infection (yes or no), and duration and cost of hospitalization. RESULTS: Wound infection developed in 10 (10%) of 99 patients who did not receive antibiotics. Of 93 patients who received perioperative antibiotics, three (3.3%) developed wound infection. This difference was not statistically significant. The type II (beta) error was greater than 0.2, suggesting that a significant difference may have been missed (false-negative) as a result of the small number of patients studied. The excess cost accrued to each patient who developed a postoperative wound infection was in excess of $36,000 (1992 dollars). The cost of administration of antibiotic prophylaxis to 100 patients is less than this amount. CONCLUSION: The decision to withhold antibiotic prophylaxis should not be made in an effort to reduce hospital costs.

Revisión de cefalosporinas orales: bases para una elección racional / Review of oral cephalosporins: basis for a racional choice

Las cefalosporinas orales son antibióticos beta lactámicos de amplio espectro, frecuentemente usados en el tratamiento de infecciones de la comunidad en forma empírica o previa comprobación microbiológica, tanto en las debidas a gérmenes gram positivos como negaticos. Diferen entre ellas respecto a su espectro y potencia antimicrobiana, resistencia bacteriana, farmacocinética y costo. En general las cefalosporinas de 1 ra. generación son más activas sobre los gram positivos, tienen menos resistencia a las beta lactamasas de los negativos, menor t 1/2 y menor costo. Las de 2da. generación amplían su espectro, por aumento de resistencia a las beta lactamasas y presentan vida media más larga. Los agentes de 3ra. generación son los más activos frente a enterobacterias, tienen alta resistencia a las beta lactamasas, propiedades farmacocinéticas mejoradas que permiten una o dos administraciones diárias y mayor costo. La habilidad en la elección y uso de las cefalosporinas, continúa siendo un desafío para el médico clínico, ya que el desarrollo de nuevas cefalosporinas continúa (impulsado por el avance de la resistencia bacteriana que ha afectado todos los pasos del mecanismo íntimo de acción de estas drogas) y que en un futuro cercano serán introducidas nuevas cefalosporinas en el mercado

Revisión de cefalosporinas orales: bases para una elección racional / Review of oral cephalosporins: basis for a racional choice

Las cefalosporinas orales son antibióticos beta lactámicos de amplio espectro, frecuentemente usados en el tratamiento de infecciones de la comunidad en forma empírica o previa comprobación microbiológica, tanto en las debidas a gérmenes gram positivos como negaticos. Diferen entre ellas respecto a su espectro y potencia antimicrobiana, resistencia bacteriana, farmacocinética y costo. En general las cefalosporinas de 1 ra. generación son más activas sobre los gram positivos, tienen menos resistencia a las beta lactamasas de los negativos, menor t 1/2 y menor costo. Las de 2da. generación amplían su espectro, por aumento de resistencia a las beta lactamasas y presentan vida media más larga. Los agentes de 3ra. generación son los más activos frente a enterobacterias, tienen alta resistencia a las beta lactamasas, propiedades farmacocinéticas mejoradas que permiten una o dos administraciones diárias y mayor costo. La habilidad en la elección y uso de las cefalosporinas, continúa siendo un desafío para el médico clínico, ya que el desarrollo de nuevas cefalosporinas continúa (impulsado por el avance de la resistencia bacteriana que ha afectado todos los pasos del mecanismo íntimo de acción de estas drogas) y que en un futuro cercano serán introducidas nuevas cefalosporinas en el mercado (AU)