Premium
Experience with Ceftazidime Parenteral‐to‐Parenteral Dosage Stepdown in the Empiric Treatment of Febrile Neutropenia
Author(s) -
Schwagly Nadine,
Frighetto Luciana,
MacDougall Cathy,
Jewesson Peter
Publication year - 1999
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 - 10.1592/phco.19.8.641.31519
Subject(s) - medicine , ceftazidime , neutropenia , discontinuation , febrile neutropenia , intensive care medicine , adverse effect , chemotherapy , bacteria , pseudomonas aeruginosa , biology , genetics
We assessed the clinical and economic impact of a new parenteral‐to‐parenteral stepdown program involving ceftazidime for the treatment of febrile neutropenia. This was a two‐phase (before and after), 12‐month, single‐center, prospective study with a historical control. Ninety‐eight ceftazidime treatment courses (47 preintervention, 51 postintervention) were administered for management of febrile neutropenia in 85 adults with hematologic malignancies. Multidisciplinary creation and promotion of parenteral‐to‐parenteral ceftazidime stepdown criteria were applied at the discretion of the health care team. Patient demographics between phases were similar. Only 2 (4%) treatment courses before the intervention involved parenteral‐to‐parenteral dosage stepdown, compared with 34 (67%) after the intervention (p< 0.00001). Mean number of total ceftazidime doses/treatment course and mean duration of therapy did not change between phases. Clinical cure or improvement was identified in 74% and 80% of treatment courses before and after the intervention, respectively. The two main reasons for discontinuing the drug before the intervention were recovery of neutrophil count (60%) and adverse reactions (19%). Neutrophil count recovery (59%) and hospital discharge (14%) were the two most common reasons for discontinuation after the intervention. Of 34 stepdown treatment courses after the intervention, 3 (9%) failed to meet established stepdown criteria, and 2 of these required stepdown reversal. Ancillary antibacterial drugs and treatment course outcomes were similar between phases. Total ceftazidime acquisition cost for 704 treatment days in the preintervention phase was $52,473 CAN compared with $54,778 CAN for 907 days of therapy in the postintervention phase. The mean acquisition cost/ceftazidime treatment course was $1100 CAN and did not differ between phases. The mean daily cost of ceftazidime therapy was lower after the intervention ($60.39 vs $74.54 CAN) as a result of a greater frequency of stepdown (p< 0.001). Assuming an equivalent number of treatment days, the projected annual acquisition cost avoidance associated with this stepdown program was $19,900 CAN.