Pharmacoeconomic

Community-acquired pneumonia (CAP) is a serious and widespread infection due to its high incidence, morbidity, mortality and increased healthcare costs. This study aimed at investigating antibiotic combination regimen containing fluoroquinolone (Group A) and antibiotic combination regimen not containing fluoroquinolone (Group B) in terms of effectiveness parameters and direct medical costs associated with treatment of CAP patients admitted to Intensive Care Unit (ICU). This study was designed as retrospective and prospective observational studies including CAP patients admitted to the Respiratory ICU. The patients’ files were collected and the effectiveness parameters of outcomes were compared on admission and on discharge. Effectiveness and costs analyses between antibiotic regimens either containing or not containing fluoroquinolone were performed. A total of 16 patients were enrolled in our retrospective study; (Group A) included 7 patients, while (Group B) included 9 patients. The prospective study included 30 patients; (Group A) included 13 patients and (Group B) included 17 patients. There was non-significant difference in the number of days in ICU between the two groups with a trend to shorter length of stay in ICU in (Group B) compared to (Group A) in both retrospective and prospective studies. Cost analysis showed that there was non-significant difference with a trend to lower direct medical costs in (Group B) which resulted in cost savings of (L.E) 1277 and (L.E) 816 for retrospective study and prospective study respectively. In conclusion, regimens containing or not containing fluoroquinolone did not show a significant increase in either effectiveness or costs of CAP treatment in the ICU

A specially tailored vancomycin continuous infusion regimen for renally impaired critically ill patients

Background: Vancomycin remains the gold standard for treatment of methicillin-resistant Staphylococcus aureus . Specially designed continuous infusion of vancomycin leads to better therapy. Methodology: A total of 40 critically ill patients who suffered from pneumonia susceptible to vancomycin, had serum creatinine >1.4 mg%, and oliguria <0.5 mL/kg/h for 6 h were included in the study with respiratory culture sensitivity to vancomycin ≤2 mg/L. Patients’ clinical, microbiological, and biological data were obtained by retrospective analysis of the corresponding medical files before and after vancomycin treatment. Patients with serum creatinine level ≥4 mg% and patients who received renal replacement therapy during the treatment period were excluded. The patients were divided into two groups—group 1 (intermittent dosing) and group 2 (continuous infusion) based on the following formula: rate of vancomycin continuous infusion (g/day) = [0.0205 creatinine clearance (mL/min) + 3.47] × [target vancomycin concentration at steady state (µg/mL)] × (24/1000). Trough vancomycin serum levels were also assessed using high-performance liquid chromatographic technique. Patients’ outcomes such as clinical improvement, adverse events, and 15-day mortality were reported. Results: Group 2 showed significant reduction in blood urea nitrogen, creatinine serum levels, white blood cells, partial carbon dioxide pressure, body temperature, and Sequential Organ Failure Assessment score, while significant increase in partial oxygen pressure and saturated oxygen was also observed. A significantly shorter duration of treatment with a comparable vancomycin serum levels was also reported with group 2. Conclusion: After treatment, comparison in patients’ criteria supports the superiority of using continuous infusion of vancomycin according to this equation in renally impaired patients