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Antibiotic therapeutic interchange program: six years of experience.

https://arctichealth.org/en/permalink/ahliterature215834
Source
Hosp Formul. 1995 Feb;30(2):92-3, 97-8, 100 passim
Publication Type
Article
Date
Feb-1995
Author
L. Frighetto
D. Nickoloff
P. Jewesson
Author Affiliation
Vancouver Hospital and Health Sciences Centre, B.C.
Source
Hosp Formul. 1995 Feb;30(2):92-3, 97-8, 100 passim
Date
Feb-1995
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents - administration & dosage - therapeutic use
British Columbia
Cost Savings
Drug Costs
Drug Utilization Review - economics - statistics & numerical data
Hospital Bed Capacity, 500 and over
Hospitals, Teaching
Humans
Medication Systems, Hospital - organization & administration
Practice Guidelines as Topic
Program Development
Retrospective Studies
Therapeutic Equivalency
Abstract
To assess the long-term impact of a therapeutic interchange program on the use of target antimicrobial drugs, we conducted a retrospective study of target drug utilization at our institution--a 1,000-bed Canadian tertiary care teaching hospital. Data were assessed to determine target drug utilization, incidence of therapeutic interchanges, and patient-target drug exposures. Results showed that the incidence of therapeutic interchanges per patient-target drug exposure decreased from a mean of 23% to 2%, resulting in a total net savings for the target drugs of approximately $1.07 million (Canadian) over 6 years. Prescriber acceptance and low manpower requirements combine to make this a useful method of altering prescribing patterns and reducing drug and drug delivery costs.
PubMed ID
10140352 View in PubMed
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Ciprofloxacin use under a reserved drug and stepdown promotion program.

https://arctichealth.org/en/permalink/ahliterature215833
Source
Can J Hosp Pharm. 1995 Feb;48(1):35-42
Publication Type
Article
Date
Feb-1995
Author
L. Frighetto
S M Martinusen
F. Mamdani
P J Jewesson
Author Affiliation
Vancouver Hospital and Health Sciences Centre, BC.
Source
Can J Hosp Pharm. 1995 Feb;48(1):35-42
Date
Feb-1995
Language
English
Publication Type
Article
Keywords
Adult
British Columbia
Ciprofloxacin - economics - therapeutic use
Data Collection
Drug Costs
Drug Utilization Review - statistics & numerical data
Hospital Bed Capacity, 500 and over
Hospitals, Teaching
Humans
Male
Parenteral Nutrition
Pharmacy Service, Hospital - economics
Research Design
Retrospective Studies
Treatment Outcome
Abstract
This study retrospectively evaluated the use of parenteral ciprofloxacin (PC) under the influence of a reserved antimicrobial drug program and an intravenous-oral stepdown program. During the first three months following its formulary introduction, 92 PC treatment courses were initiated. Fifty of these treatment courses in 49 adults were randomly selected for study. The hematology service accounted for 50% of the courses reviewed. The balance were initiated in the intensive care unit (16%), and six other services (34%). PC was used for the treatment of febrile neutropenia (50%), respiratory tract infections (20%), gram-negative sepsis (10%), and five other indications. Initial use of the intravenous formulation was considered appropriate in 92% of courses. Stepdown therapy occurred in 17 (34%) of treatment courses. Of the 26 patients considered candidates for oral therapy, seven patients (27%) were eligible for earlier stepdown and nine patients (35%) did not receive oral drug. According to our criteria, unnecessary use of the intravenous route occurred in 20% of PC treatment days. Mean total cost (acquisition plus delivery) of therapy per course was $668. This cost was higher in the hematology service (mean $990) than any other service (p = 0.0015). When stepdown therapy was employed the mean daily cost of therapy was $43.63 vs. $55.61 when the oral dosage form was not used (p = 0.04). Parenteral drug costs totalling $6245 were avoided by subsequent use of the oral dosage form. If full compliance with stepdown criteria had occurred, an estimated total savings of $10,769 could have been realized.
PubMed ID
10141061 View in PubMed
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Comparison of cefoxitin and ceftizoxime in a hospital therapeutic interchange program.

https://arctichealth.org/en/permalink/ahliterature221367
Source
CMAJ. 1993 Apr 1;148(7):1161-9
Publication Type
Article
Date
Apr-1-1993
Author
S. Martinusen
D. Chen
L. Frighetto
D. Bunz
H G Stiver
P J Jewesson
Author Affiliation
Department of Pharmacy, Vancouver General Hospital, BC.
Source
CMAJ. 1993 Apr 1;148(7):1161-9
Date
Apr-1-1993
Language
English
Publication Type
Article
Keywords
Adult
Aged
British Columbia
Cefoxitin - economics - therapeutic use
Ceftizoxime - economics - therapeutic use
Cost Savings
Cost-Benefit Analysis
Drug Costs - statistics & numerical data
Drug Utilization - economics - statistics & numerical data
Female
Formularies, Hospital
Hospital Bed Capacity, 500 and over
Hospitals, Teaching - economics
Humans
Male
Middle Aged
Treatment Outcome
Abstract
To determine whether (a) ceftizoxime can replace cefoxitin in the prevention and treatment of various infections in a major teaching hospital, (b) a previously applied two-stage intervention program is an effective method of instituting a therapeutic interchange of ceftizoxime for cefoxitin and (c) the replacement of cefoxitin with ceftizoxime results in a more cost-effective therapy.
Two-phase, open, sequential study.
Tertiary care teaching hospital.
One hundred patients who received cefoxitin during the 6 months immediately before the start of the interchange program (phase 1) and 100 who received ceftizoxime during the 6 months immediately after the start of the program (phase 2) were randomly selected.
The demographic characteristics of the two patient groups were similar except for sex (p
Notes
Cites: Ann Surg. 1983 Oct;198(4):525-306354113
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Cites: Drug Intell Clin Pharm. 1988 Sep;22(9):726-73215122
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Cites: J Infect Dis. 1989 Sep;160(3):433-412668427
Cites: Rev Infect Dis. 1984 Mar-Apr;6 Suppl 1:S283-926326244
PubMed ID
8457957 View in PubMed
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Cost analysis of an adult outpatient parenteral antibiotic therapy (OPAT) programme. A Canadian teaching hospital and Ministry of Health perspective.

https://arctichealth.org/en/permalink/ahliterature196130
Source
Pharmacoeconomics. 2000 Nov;18(5):451-7
Publication Type
Article
Date
Nov-2000
Author
A O Wai
L. Frighetto
C A Marra
E. Chan
P J Jewesson
Author Affiliation
Vancouver Hospital and Health Sciences Centre and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Source
Pharmacoeconomics. 2000 Nov;18(5):451-7
Date
Nov-2000
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Ambulatory Care - economics - methods
Anti-Bacterial Agents - administration & dosage - economics
Canada
Government Agencies
Home Infusion Therapy - economics
Hospitals, Teaching
Humans
Infusions, Parenteral - economics
Middle Aged
Prospective Studies
Abstract
Outpatient parenteral antibiotic therapy (OPAT) programmes have become prevalent over the past 2 decades. From the US perspective, these programmes have been shown to reduce healthcare costs. No comprehensive analysis has been published from the Canadian perspective.
To describe a Canadian OPAT programme for the 3-year period since its inception and to conduct a treatment cost analysis.
Demographics and resource utilisation data (health professional labour, laboratory and diagnostic tests, antimicrobials, delivery, home nursing care, catheters and catheter placement) were prospectively collected for enrollees in the OPAT programme over the evaluation period. Avoided hospital resource utilisation was estimated via retrospective chart review by the investigators. Costs were retrospectively assigned to each resource and total cost avoidance by the OPAT programme was determined from each perspective.
A teaching hospital and a provincial Ministry of Health (MOH).
140 treatment courses were initiated for 117 adult patients (mean age 54 years) who were enrolled into the programme. Mean pre-OPAT length of hospital stay was 12 days, and mean OPAT duration was 22.5 days. Bone/joint (39%), skin and soft tissue (16%), cardiac (13%) and respiratory tract (12%) infections were the most common infections managed. The most commonly used antimicrobials were vancomycin (29%), cloxacillin +/- gentamicin (22%) and ceftriaxone +/- gentamicin (11%) 85% of enrollees successfully completed their planned antimicrobial treatment regimens. Premature discontinuation of antimicrobial therapy for various reasons occurred in the remaining 15% of courses. The mean cost per treatment course of OPAT was 1910 Canadian dollars ($Can) from the hospital perspective and $Can6326 from the MOH perspective. Assuming that patients would have otherwise completed their antimicrobial therapy in hospital, the mean cost per treatment course was estimated to be $Can14,271. The overall cost avoidance of the OPAT programme was $Can1,730,520 (hospital perspective) and $Can1,009,450 (MOH perspective) over the 3-year assessment period. Sensitivity analyses revealed the results to be robust to plausible changes.
This analysis supports the premise that an adult OPAT programme can substantially reduce healthcare costs in the Canadian healthcare setting.
PubMed ID
11151398 View in PubMed
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Cost-effectiveness analysis of abciximab: a Canadian hospital perspective.

https://arctichealth.org/en/permalink/ahliterature205550
Source
Ann Pharmacother. 1998 May;32(5):536-42
Publication Type
Article
Date
May-1998
Author
P J Zed
L. Frighetto
R. Sunderji
C A Marra
Author Affiliation
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
Source
Ann Pharmacother. 1998 May;32(5):536-42
Date
May-1998
Language
English
Publication Type
Article
Keywords
Angioplasty, Balloon, Coronary
Antibodies, Monoclonal - adverse effects - economics - therapeutic use
Canada
Coronary Disease - drug therapy - economics - prevention & control
Cost-Benefit Analysis
Hemorrhage - chemically induced
Humans
Immunoglobulin Fab Fragments - adverse effects - economics - therapeutic use
Platelet Aggregation Inhibitors - adverse effects - economics - therapeutic use
Abstract
To assess the cost-effectiveness of abciximab therapy versus traditional practice in high-risk patients receiving percutaneous transluminal coronary angioplasty (PTCA) from a Canadian hospital perspective.
A predictive decision analytic model using published clinical and economic evaluations, as well as costs of medical care in Canada.
High-risk PTCA patients as defined by the Evaluation of c7E3 for Prevention of Ischemic Complications trial and the c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina trial.
Two treatment strategies were compared: (1) abciximab 0.25 mg/kg intravenous bolus 10 minutes prior to PTCA followed by abciximab 10 micrograms/min intravenous infusion for 12 hours after the procedure, and (2) no abciximab adjunctive therapy at the time of PTCA. Both treatment strategies were combined with intravenous heparin up to 100 units/kg bolus pre-PTCA followed by bolus doses for 1 hour after PTCA per the protocol. Cumulative outcomes were considered up to 6 months after initial PTCA.
At 6 months, 29% of the patients in the abciximab treatment arm compared with 33% in the no abciximab arm achieved one of the primary events. The most common adverse event experienced was major bleeding at 4% in the abciximab treatment arm versus 1.6% in the no abciximab arm. The average cost per patient for each strategy was $3261 Can ($1 Can = $0.686 US) (abciximab arm) versus $2073 Can (no abciximab arm), resulting in an incremental cost-effectiveness ratio of $29,700 Can per event-free patient. In univariate sensitivity analyses, the only controllable factor that changed the results of the cost-effectiveness outcome was the cost of abciximab.
Although the use of abciximab as an adjunct to PTCA results in a reduction in event rates in high-risk patients compared with traditional treatment, there is an increased cost associated with this strategy.
Notes
Erratum In: Ann Pharmacother 1998 Jul-Aug;32(7-8):845
PubMed ID
9606473 View in PubMed
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Cost-effectiveness analysis of enoxaparin versus unfractionated heparin for acute coronary syndromes. A Canadian hospital perspective.

https://arctichealth.org/en/permalink/ahliterature199602
Source
Pharmacoeconomics. 1999 Nov;16(5 Pt 2):533-42
Publication Type
Article
Date
Nov-1999
Author
R M Balen
C A Marra
P J Zed
M. Cohen
L. Frighetto
Author Affiliation
University of British Columbia, Vancouver General Hospital, Canada.
Source
Pharmacoeconomics. 1999 Nov;16(5 Pt 2):533-42
Date
Nov-1999
Language
English
Publication Type
Article
Keywords
Acute Disease
Anticoagulants - economics - therapeutic use
Canada
Coronary Disease - drug therapy - economics - mortality
Cost-Benefit Analysis
Decision Support Techniques
Enoxaparin - economics - therapeutic use
Heparin - economics - therapeutic use
Hospitals
Humans
Abstract
To determine the cost effectiveness of enoxaparin therapy versus unfractionated heparin (UFH) therapy for patients with unstable coronary artery disease from the perspective of a Canadian hospital.
A predictive decision analysis model using published clinical and economic evaluations and costs of medical care in Canada.
A hypothetical cohort of patients presenting to hospital with unstable angina or non-Q-wave myocardial infarction as defined by the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) trial.
Two antithrombotic treatment strategies were compared: (i) enoxaparin 1 mg/kg subcutaneously every 12 hours, and (ii) UFH intravenous bolus and constant infusion adjusted to maintain a therapeutic activated partial thromboplastin time. Both treatment strategies included 100 to 325 mg of oral aspirin daily. Enoxaparin or UFH was continued for a minimum of 48 hours to a maximum of 8 days. Cumulative outcomes were considered up to 30 days after initial presentation to hospital.
At 30 days, 19.8% of patients who received enoxaparin compared with 23.3% of patients who received UFH reached one of the primary composite events. There was no difference in major bleeding between the 2 treatment groups (6.5% enoxaparin vs 6.8% UFH). The average total direct medical cost per patient was $Can848 with the enoxaparin strategy versus $Can892 with the UFH strategy (1999 values). Therapy with enoxaparin was, therefore, considered to be the dominant strategy. Univariate sensitivity analysis indicated that the decision model was not robust to changes in the 30-day composite end-point, probability of recurrent angina, or base costs for treatment of recurrent angina or enoxaparin therapy.
Enoxaparin is the dominant antithrombotic pharmacotherapeutic strategy for patients with unstable coronary artery disease.
PubMed ID
10662478 View in PubMed
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Cost-effectiveness of prophylactic dolasetron or droperidol vs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery.

https://arctichealth.org/en/permalink/ahliterature201643
Source
Can J Anaesth. 1999 Jun;46(6):536-43
Publication Type
Article
Date
Jun-1999
Author
L. Frighetto
P S Loewen
J. Dolman
C A Marra
Author Affiliation
Clinical Drug Research Program, CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, BC, Canada.
Source
Can J Anaesth. 1999 Jun;46(6):536-43
Date
Jun-1999
Language
English
Publication Type
Article
Keywords
Ambulatory Surgical Procedures - adverse effects
Antiemetics - administration & dosage - adverse effects - economics - therapeutic use
Canada
Cost-Benefit Analysis
Decision Support Techniques
Decision Trees
Droperidol - administration & dosage - adverse effects - economics - therapeutic use
Drug Costs
Female
Forecasting
Gynecologic Surgical Procedures - adverse effects
Humans
Indoles - administration & dosage - adverse effects - economics - therapeutic use
Injections, Intravenous
Intraoperative Care - economics
Metoclopramide - economics - therapeutic use
Postoperative Nausea and Vomiting - drug therapy - economics - prevention & control
Probability
Prochlorperazine - economics - therapeutic use
Quinolizines - administration & dosage - adverse effects - economics - therapeutic use
Sensitivity and specificity
Treatment Outcome
Abstract
To assess the cost-effectiveness of prophylactic therapy (1.25 mg droperidol or 50 mg dolasetron i.v.) vs no prophylaxis (rescue therapy) for the prevention of post-operative nausea and vomiting (PONV) from a Canadian hospital perspective.
A predictive decision analytic model using previously published clinical and economic evaluations, and costs of medical care in Canada.
Ambulatory gynecology surgery patients.
Three strategies administered prior to emergence from anesthesia were compared: 1.25 mg droperidol i.v., 50 mg dolasetron i.v.; and no prophylaxis (rescue therapy).
The base case mean cost per patient receiving dolasetron prophylaxis was $28.08 CAN compared with $26.88 CAN per patient receiving droperidol prophylaxis, resulting in a marginal cost of $1.20 CAN. This difference translated in an additional cost of $12.00 CAN for the dolasetron strategy per adverse event avoided over the droperidol strategy. The base case mean cost per patient not receiving prophylaxis was $26.92 resulting in marginal costs of $1.16 CAN and $0.04 CAN when compared to dolasetron and droperidol, respectively. Compared with the no prophylaxis strategy, dolasetron prophylaxis resulted in an incremental cost-effectiveness ratio of $5.82 CAN per additional PONV-free patient. The mean costs incurred per PONV-free patient were calculated to be $48.41 for the dolasetron strategy, $46.34 for the droperidol strategy and $70.83 for the no prophylaxis strategy.
Dolasetron and droperidol given intraoperatively were more cost-effective than no prophylaxis for PONV in patients undergoing ambulatory gynecologic surgery. The difference between the two agents was small and favoured droperidol. The model was robust to plausible changes through sensitivity analyses.
PubMed ID
10391600 View in PubMed
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Cost-Utility analysis of tissue plasminogen activator therapy for acute ischaemic stroke: a Canadian healthcare perspective.

https://arctichealth.org/en/permalink/ahliterature192595
Source
Pharmacoeconomics. 2001;19(9):927-36
Publication Type
Article
Date
2001
Author
S E Sinclair
L. Frighetto
P S Loewen
R. Sunderji
P. Teal
S C Fagan
C A Marra
Author Affiliation
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
Source
Pharmacoeconomics. 2001;19(9):927-36
Date
2001
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cost-Benefit Analysis
Decision Support Techniques
Fibrinolytic Agents - economics - therapeutic use
Hospitalization - economics
Humans
Markov Chains
Myocardial Ischemia - drug therapy - economics - epidemiology
Quality-Adjusted Life Years
Tissue Plasminogen Activator - economics - therapeutic use
Abstract
There are over 40000 ischaemic strokes annually in Canada, which result in significant morbidity, mortality and burden to the healthcare system. A recent, large clinical trial has evaluated tissue plasminogen activator (t-PA) intravenously for the treatment of acute ischaemic stroke with promising outcomes but with an increased risk of symptomatic intracranial haemorrhage.
To compare clinical and economic outcomes of intravenous t-PA therapy (0.9 mg/kg, to a maximum of 90 mg, initiated within 3 hours of stroke onset) versus no t-PA for acute ischaemic stroke based on the outcomes achieved in the National Institute of Neurological Disorders and Stroke (NINDS) trial.
A Markov model depicting the natural lifetime course after an initial acute ischaemic stroke. On the basis of this model, a simulated trial compared no t-PA with t-PA.
A hypothetical cohort of 1000 patients with acute ischaemic stroke.
Canadian healthcare system.
Total acute stroke and post-stroke treatment costs and cumulative quality-adjusted life-years (QALYs).
For a hypothetical cohort of 1000 patients, the estimated lifetime stroke costs were 103100000 Canadian dollars (SCan) [1999 values) in the t-PA arm ($Can103100 per patient) compared with SCan106900000 in the no t-PA arm ($Can106900 per patient), yielding a lifetime cost difference of $Can3800000 in favour of t-PA versus no t-PA (SCan3800 per patient). In the hypothetical cohort, t-PA treatment resulted in 13 130 QALYs versus 9670 QALYs with no t-PA treatment. This translated into a net benefit of 3460 additional QALYs per 1000 patients (3.46 QALYs per patient). No treatment, outcome or economic variables influenced the model outcome.
From the standpoint of cost effectiveness, treatment of acute ischaemic stroke with intravenous t-PA is an economically attractive strategy.
PubMed ID
11700779 View in PubMed
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Implementation and evaluation of a standardized herpes simplex virus prophylaxis protocol on a leukemia/bone marrow transplant unit.

https://arctichealth.org/en/permalink/ahliterature217869
Source
Ann Pharmacother. 1994 Jul-Aug;28(7-8):852-6
Publication Type
Article
Author
S A Rayani
C J Nimmo
L. Frighetto
S M Martinusen
D M Nickoloff
D E Reece
P J Jewesson
Author Affiliation
Department of Pharmacy, Vancouver General Hospital, British Columbia, Canada.
Source
Ann Pharmacother. 1994 Jul-Aug;28(7-8):852-6
Language
English
Publication Type
Article
Keywords
Acyclovir - administration & dosage - therapeutic use
Adult
Bone Marrow Transplantation
British Columbia
Clinical Protocols
Drug Costs
Female
Herpes Simplex - prevention & control
Hospitals, Teaching
Humans
Leukemia - therapy
Male
Middle Aged
Abstract
To assess the impact of a standardized acyclovir prophylaxis protocol for the prevention of herpes simplex virus (HSV) infection and disease in bone marrow transplant and leukemic patients.
Two-phase, open sequential study involving prospective patient monitoring and retrospective health record review.
Tertiary care teaching hospital.
Fifty-seven patients (35 preprotocol, 22 postprotocol) who received acyclovir for HSV prophylaxis during an 18-month study period.
An acyclovir HSV prophylaxis protocol was developed and implemented. Under this protocol, all HSV immunoglobulin G-seropositive hematology patients received an acyclovir regimen of 125 mg/m2 i.v. q6h or 600 mg p.o. q6h (if tolerated) from day -5 to day 30. Regimens not matching protocol were modified by pharmacists in conjunction with the prescriber. All treatment courses were followed daily by pharmacists to modify dosage according to renal function and assess appropriateness of the i.v. route. Tablets, capsules, or suspensions were promoted if the patient was considered tolerant of the oral route.
Outcome parameters included (1) incidence of parenteral, oral, or combined therapy; (2) total prophylactic acyclovir dose per patient; (3) mean prophylactic acyclovir daily dose; (4) mean duration of acyclovir prophylaxis; and (5) HSV reactivation rate.
Following implementation of the protocol, the mean total i.v. acyclovir dose per patient decreased from 20.1 g (range 3.6-109.5) to 11.7 g (range 1.0-43.0; p = 0.1162). The mean cumulative oral dose increased from 12.1 g (range 0.4-70.0) to 33.1 g (range 2.4-93.6; p = 0.0007). Mean duration of therapy increased from 27.6 to 33.5 days (p = 0.23). The mean duration of oral therapy increased from 10.5 days (+/- SD 10.9) to 17.2 days (+/- SD 12.1) (p = 0.034). The appropriateness of use of the i.v. dosage form increased from 53 to 88 percent of treatment days (p = 0.013). No difference in HSV reactivation rate was observed when comparing patients prior to and following protocol implementation. A drug acquisition savings of $1112.00 (CDN) per patient was realized.
The implementation of a standardized HSV acyclovir prophylaxis protocol has resulted in significant drug acquisition cost savings without an apparent negative impact on patient outcome.
PubMed ID
7949499 View in PubMed
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Intravenous-to-oral stepdown program: four years of experience in a large teaching hospital.

https://arctichealth.org/en/permalink/ahliterature222785
Source
Ann Pharmacother. 1992 Nov;26(11):1447-51
Publication Type
Article
Date
Nov-1992
Author
L. Frighetto
D. Nickoloff
S M Martinusen
F S Mamdani
P J Jewesson
Author Affiliation
Vancouver General Hospital, BC, Canada.
Source
Ann Pharmacother. 1992 Nov;26(11):1447-51
Date
Nov-1992
Language
English
Publication Type
Article
Keywords
Administration, Oral
Anti-Bacterial Agents - administration & dosage - economics
Anti-Infective Agents - administration & dosage - economics
British Columbia
Drug Costs
Hospital Bed Capacity, 500 and over
Hospitals, Teaching
Humans
Infusions, Intravenous
Medication Systems, Hospital - economics
Progressive Patient Care - economics
Retrospective Studies
Time Factors
Abstract
To assess the impact of an intravenous-to-oral (iv-po) stepdown program on the relative use of oral and parenteral dosage forms of select antimicrobials.
A retrospective review of drug utilization records before and after a trial comparing metronidazole and clindamycin prescribing trends from a 12-month baseline period to a four-year follow-up period.
One thousand-bed Canadian tertiary care referral teaching center.
An authorized iv-po stepdown program was developed to promote the oral route of drug administration. Reminders of iv-po stepdown were produced for metronidazole and clindamycin and these notes were sent to nursing units with the parenteral dosage form. The notes then were attached to the front of the health record to serve as a reminder to prescribers that an equally effective, well-tolerated, and less-expensive oral dosage form was available for use.
A 44 percent relative increase in the use of oral metronidazole and a 79 percent relative increase in the use of oral clindamycin occurred. When acquisition and delivery costs were considered, cumulative cost savings from 1988 to 1991 resulted for metronidazole ($31,920) and clindamycin ($53,880).
This intervention represents a simple yet effective method of promoting a process of stepdown from parenteral to oral antibiotic therapy.
PubMed ID
1477451 View in PubMed
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10 records – page 1 of 1.