Premium
Pharmacoeconomics of Aztreonam‐Clindamycin versus Gentamicin‐Clindamycin in the Treatment of Penetrating Abdominal Injury
Author(s) -
Fabian Timothy C.,
Boucher Bradley A.,
Croce Martin C.
Publication year - 1996
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1996.tb03014.x
Subject(s) - medicine , clindamycin , gentamicin , pharmacoeconomics , aztreonam , anesthesia , surgery , antibiotics , intensive care medicine , antibiotic resistance , imipenem , microbiology and biotechnology , biology
Study Objective . To evaluate the pharmacoeconomic implications of using aztreonam‐clindamycin (A‐C) versus gentamicin‐clindamycin (G‐C) from the perspective of the hospital and pharmacy directors. Design . Pharmacoeconomic analysis performed at one of the sites participating in the prospective, randomized, double‐blind, comparative, multicenter efficacy study. Setting . Referral hospital with level 1 trauma center. Patients . Eight‐five adults with a suspected penetrating intraabdominal injury requiring laparotomy. Interventions . Patients were randomized to receive aztreonam 2 g intravenously every 8 hours or gentamicin 2 mg/kg intravenous load followed by 5 mg/kg/day intravenously initially adjusted to peak concentrations of 6–8 μg/ml. All patients received clindamycin 900 mg intravenously every 8 hours. Measurements and Main Results . Charge data were gathered from the hospital billing system and converted to cost data using an institutional cost:charge ratio of 0.6. Study drug and aminoglycoside monitoring costs were also calculated. Overall, 43 (97%) of 44 patients receiving A‐C had a favorable clinical response compared with 35 (85.4%) of 41 receiving G‐C (p=0.052). The mean hospital cost of $66,336 for 7 infected patients was significantly higher than that of $8014 in 78 noninfected patients (p>0.0001). Mean hospital costs of $12,058 and $13,742 for A‐C and G‐C groups, respectively, were not significantly different (p<0.05) despite having only a single failure (total cost $162,666) in the A‐C group. Similarly, mean pharmacy costs of $1411 and $1604, respectively, were not significantly different (p>0.05). Conclusions . Hospital costs for infected patients with penetrating abdominal trauma exceed those of noninfected patients by 5‐fold. Despite a lower infection rate in the A‐C group, neither hospital nor pharmacy costs were significantly different compared with those in the G‐C group.