Raymond J. Townsend

Evaluating the Cost Impact of Intravenous Antibiotic Dosing Frequencies

Cost differences between antibiotic dosing frequencies were studied at Robert Wood Johnson University Hospital. Developing a complete cost profile between antibiotic alternatives is difficult because of role separation within the hospital. To present a more complete profile, the study analyzed the incremental costs associated with the hospital pharmacy and nursing staffs regarding various dosing frequencies, including different iv admixture and administration methods. Results showed that administration of an antibiotic dose costs approximately

Pharmacokinetic Comparison of Three Clindamycin Phosphate Dosing Schedules

3.35 based on labor and material costs associated with admixture and administration. An average of 4.6 minutes/dose saves nurses up to 23 minutes for each patient who receives an antibiotic dosed once rather than six times daily over a 24-hour period. Costs of administration and admixture should be considered in comparisons of combination therapy with monotherapy when deciding between two therapeutically equivalent alternatives.

Comparative Clinical, Microbiologic, and Economic Audit of the Use of Oral Ciprofloxacin and Parenteral Antimicrobials:

In a randomized, three-way crossover study, six male volunteers received clindamycin phosphate 600 mg iv q6h (treatment A), 600 mg iv q8h (treatment B), or 900 mg iv q8h (treatment C). Plasma clindamycin concentrations were determined periodically for eight hours after achieving steady state. The results indicate that treatment C yielded significantly higher peak plasma clindamycin concentrations than treatments A or B. There were no significant differences in minimum plasma clindamycin concentrations (Cmin) or area under the plasma concentration versus time curve (AUC24) between treatments A and C. However, both treatments A and C yielded significantly greater Cmjn and AUC24 values than treatment B. There were no significant differences among treatments for clindamycin clearance. It is concluded that clindamycin phosphate 900 mg q8h is a pharmacokinetically acceptable alternative to clindamycin phosphate 600 mg q6h.

Enalapril to Lisinopril: Economic Impact of a Voluntary Angiotensin-Converting Enzyme-Inhibitor Substitution Program in a Staff-Model Health Maintenance Organization

OBJECTIVE: To examine the use of oral ciprofloxacin and parenteral antimicrobials in the treatment of acute infection (respiratory tract, urinary tract, blood) in hospitalized patients, with particular reference to severity of infection, outcome, and associated economic implications of each treatment. DESIGN: A prospective, multicenter comparative audit was conducted in the UK over an 18-month period. The audit was undertaken by clinical pharmacists who reviewed the antimicrobial treatment of patients with infective episodes, who were receiving or could have received oral therapy. PARTICIPANTS: Clinical pharmacists who collated the data all are employed in teaching hospitals. MAIN OUTCOME MEASURES: Patients were identified for analysis by their type of infection, severity of illness, antimicrobial prescribed, route of administration, and response to therapy. Additionally, data on costs of the antimicrobials prescribed and the supplementary costs of drug administration were calculated. RESULTS: Four hundred eighty-five patients were enrolled for analysis; 208 of the patients had respiratory tract infection, 112 had urinary tract infection, 138 had septicemia, and 27 had mixed infections. Sepsis scores were applied to 152 patients receiving oral ciprofloxacin and 333 patients receiving parenteral antimicrobials and yielded mean scores of 5.9 (SD 3.1, range 1–13) and 8.7 (SD 4.2, range 1–22), respectively. of 485 patients, 188 were paired according to sepsis score results and route of administration. Resolution occurred in 133 patients (79 receiving oral and 54 receiving parenteral therapy), further therapy was required in 49 (11 oral and 38 parenteral), and treatment was withdrawn in 6 (4 oral and 2 parenteral). Microbiologic assessment yielded positive results in 227 patients (47 percent). Drug acquisition costs (based on 1 UK £ = 1.80 US

Alprostadil (Prostin VR Pediatric Sterile Solution, the Upjohn Company)

) per course of treatment were

Compatibility and Stability of Clindamycin Phosphate-Aminoglycoside Combinations Within Polypropylene Syringes

47.23 (SD

Compatibility of clindamycin phosphate with aztreonam in polypropylene syringes and with cefoperazone sodium, cefonicid sodium, and cefuroxime sodium in partial-fill glass bottles.

38.32, range 5.40–218.70) for the oral group and

Compatibility of Clindamycin Phosphate with Amikacin Sulfate at Room Temperature and with Gentamicin Sulfate and Tobramycin Sulfate under Frozen Conditions

173.70 (SD

Postmarketing Drug Research and Development

209.77, range 2.11–1021.40) for the parenteral group. Overall costs for treatment courses were

Oral Neomycin Sulfate and Erythromycin Base Before Colon Surgery: A Comparison of Serum and Tissue Concentrations

74.00 (SD