Cost-effectiveness of full-course oral levofloxacin in severe community-acquired pneumonia

Abstract

Oral levofloxacin is as efficient as sequential antibiotic treatment in community-acquired pneumonia (CAP). The current authors assessed whether oral levofloxacin treatment of patients with severe CAP, followed-up for 30 days, would save money.Over a 12-month period, 129 hospitalised patients with severe non-intensive care unit CAP were randomly assigned to receive either oral levofloxacin or sequential antibiotic treatment. Direct and indirect costs were compared over a 30-day period from several perspectives.CAP resolved in 71 out of 77 oral levofloxacin (92%) and in 34 out of 37 sequential antibiotic treatment patients (92%). Patients9 characteristics, treatment duration, hospital length of stay and mortality were similar in both groups. Drug acquisition costs were 1.7-times smaller in oral levofloxacin patients, who were less often transferred to rehabilitation centres, but they used more physicians9 visits during follow-up and their total costs were lower. As only a minority of patients was still active, inability to work and, hence, indirect costs were similar in both groups.In this study, oral levofloxacin for severe non-intensive care unit community-acquired pneumonia was equally effective as sequential antibiotic treatment, but did not lead to major costs savings except for drug acquisition costs. External factors linked with patients9 characteristics and/or medical practice are likely to play a role and should be addressed.

Guidelines for the management of adult lower respiratory tract infections - Full version

“…[391]Empirical antibiotic coverage of atypical pathogens for community‐acquired pneumonia in hospitalized adultsMA1A+Wasserfallen et al. [401]Cost‐effectiveness of full‐course oral levofloxacin in severe community‐acquired pneumoniaRCT2A+Weiss and Tillotson [405]The controversy of combination vs. monotherapy in the treatment of hospitalized community‐acquired pneumoniaMA1A+…”

Treatment strategy and risk of functional decline and mortality after nursing‐home acquired lower respiratory tract infection: two prospective studies in residents with dementia

“…Naughton and Mylotte (2000) found no benefit of parenteral over oral antibiotics in a small retrospective study, and we recently reported that no antibiotic regimen was consistently associated with 3-month mortality for US and Dutch residents at low to moderate mortality risk (Kruse et al, 2005). Clinical trials comparing oral and parenteral antibiotics for severe pneumonia in children (Rojas and Granados, 2006) and adults (Wasserfallen et al, 2004) found equal effectively.…”

Untitled

“…In den ersten Tagen sollte die Verabreichung der Antibiotika parenteral erfolgen. Eine Ausnahme bestehtje nach klinischer Konstellationfür Fluorchinolone aufgrund der hohen oralen Bioverfügbarkeit [332]. Eine weitere Ausnahme ist die orale Gabe von Makroliden im Rahmen einer Kombinationstherapie mit gleichzeitiger parenteraler Verabreichung der Betalaktamantibiotika [325].…”