Cost Effectiveness of Once‐Daily Oral Antimicrobial Therapy

Abstract

Once daily dosing of oral antimicrobials achieves significantly better patient compliance than three or four times daily dosing, and limited data suggest that this is associated with greater efficacy. Comparison of once daily and twice daily dosing is less consistent, and most studies show only marginally better compliance with once daily dosing versus twice daily dosing. Detection of urinary antimicrobial activity provides a simple method for checking compliance with oral antimicrobials and deserves wider study. Counts of residual tablets have been shown to overestimate compliance. Intravenous formulations are always more expensive than equivalent oral formulations, and preparation and administration of intravenous drugs adds significant additional costs. Moreover, intravenous regimens are complex, and a number of studies have shown that serious errors occur in both preparation and administration of intravenous drugs. There is increasing evidence that serious infections can be adequately treated with oral drugs, and the excellent bioavailability of quinolones makes them particularly attractive for these indications. Clinicians require a method for checking absorption by patients with severe infection, and the Serum Bactericidal Test may provide a practical method for monitoring a wide variety of drugs.

Pharmacokinetics of GW433908, a Prodrug of Amprenavir, in Healthy Male Volunteers

“…[15][16][17] Compliance with treatment regimens has been identified as an important determinant of long-term success of antiretroviral therapy, 16 taught us that convenience of dosing regimen enhances compliance and may also improve treatment outcome. 26 The combination of drugs currently available for use in antiretroviral treatment regimens is a complex issue. While the necessity for reductions in the frequency of dosing and the strict instructions involving dosing with meals have been recognized, most dosing regimens continue to involve multiple capsules or tablets per day, and many require restrictions on concomi-tant administration with food.…”

Effect of Food on the Bioavailability of Stavudine in Subjects with Human Immunodeficiency Virus Infection

“…Compliance with treatment has been identified as an important determinant of the long-term success of antiretroviral therapy (1,10,27), and research on antimicrobial therapy has already taught us that convenience of dosing regimen enhances compliance and may also improve outcome (7). Thus, the ability to administer d4T without regard to meals might be expected to enhance patient compliance in patients taking this antiretroviral agent.…”

The Bioavailability of the Novel Nonnucleoside Reverse Transcriptase Inhibitor GW420867X Is Unaffected by Food in Healthy Male Volunteers

“…7 Adherence to treatment has been identified as an important determinant of long-term success of antiretroviral therapy, 8,[23][24][25][26] and experience with antimicrobial therapy has already taught us that convenience of dosing regimen enhances compliance and may also improve treatment outcome. 27 The combination of drugs now available for use in antiretroviral treatment regimens is a complex issue. While the necessity for reductions in the frequency of dosing and the strict instructions involving dosing with meals have been recognized, most dosing regimens continue to involve multiple capsules or tablets per day, and many require restrictions on concomitant administration with food.…”