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Background Switching from intravenous (IV) to oral (PO) treatment as soon as patients are clinically stable can reduce the costs associated with IV administration. In this study, we selected levetiracetam, a drug with high bioavailability oral (100%) and a significant cost difference between IV and PO forms. Purpose To estimate avoidable IV levetiracetam use and analyse the potential effect on the hospital drugs budget associated with changing levetiracetam from intravenous to oral treatment. Materials and methods Retrospective observational study performed in patients admitted to the neurosurgical service treated with IV levetiracetam from March 2013 to August 2013 (6 months). We divided levetiracetam-days (LD), into IV levetiracetam days (all doses of levetiracetam were administered IV), and PO levetiracetam days (at least 1 dose administered PO). And we considered IV levetiracetam avoidable when a patient received at least one other oral drug. Data source for costs were the average wholesale prices in 2013. Results A total of 38 patients (24 men, 63%) were included in the study with a mean age of 54.3 (95% CI, 49.1–59.4) years. During study 303 LD were counted, 107 (35%) IV levetiracetam days and 196 (65%) PO levetiracetam days and a median of 2 days IV treatment (interquartile range 1–3). In this period 84 (78.5%) IV levetiracetam days were potentially avoidable, and the cost savings for conversion from IV to PO levetiracetam were calculated to be 2,066 € and the total annual cost savings in the neurosurgery unit 4,132 €. Conclusions Early switching from IV to oral levetiracetam is possible and leads to a substantial reduction in the drugs bill. Explicit physiological criteria should be recorded to serve as a benchmark for successfully switching treatment. No conflict of interest.

Resumen La estrategia escalonada en el tratamiento de la pancreatitis aguda necrotizante sobreinfectada ha demostrado, desde la publicación del estudio PANTER, su superioridad respecto al abordaje quirúrgico clásico en términos de morbilidad. Sin embargo, no es una técnica exenta de complicaciones. En nuestra imagen mostramos una de las complicaciones poco frecuentes que pueden surgir como consecuencia de esta estrategia terapéutica, y su solución quirúrgica. Se realizó un abordaje mixto (anterior y retroperitoneal) para solucionar la complicación y la pancreatitis de base en un solo tiempo. El resultado de la intervención fue satisfactorio, con buena evolución postoperatoria del paciente, que pudo irse de alta sin presentar más complicaciones.