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Pharmacoeconomics of aztreonam-clindamycin versus gentamicin-clindamycin in the treatment of penetrating abdominal injury

, : Pharmacoeconomics of aztreonam-clindamycin versus gentamicin-clindamycin in the treatment of penetrating abdominal injury. Pharmacotherapy. 16(5): 951-957

Study Objective: To evaluate the pharmacoeconomic implications of using aztreonam-clindamycin (A-C) versus gentamicin-clindamycin (G-C) from the perspective of the hospital and pharmacy directors. Design: Pharmacoeconomic analysis performed at one of the sites participating in the prospective, randomized, double-blind, comparative, multicenter efficacy study. Setting: Referral hospital with level 1 trauma center. Patients: Eighty-five adults with a suspected penetrating intraabdominal injury requiring laparotomy. Interventions: Patients were randomized to receive aztreonam 2 g intravenously every 8 hours or gentamicin 2 mg/kg intravenous load followed by 5 mg/kg/day intravenously initially adjusted to peak concentrations of 6-8 mu-g/ml. All patients received clindamycin 900 mg intravenously every 8 hours. Measurements and Main Results: Charge data were gathered from the hospital billing system and converted to cost data using an institutional cost:charge ratio of 0.6. Study drug and aminoglycoside monitoring costs were also calculated. Overall, 43 (97%) of 44 patients receiving A-C had a favorable clinical response compared with 35 (85.4%) of 41 receiving G-C (p=0.052). The mean hospital cost of 66,336 for 7 infected patients was significantly higher than that of 8014 in 78 noninfected patients (p lt 0.0001). Mean hospital costs of 12,058 and 13,742 for A-C and G-C groups, respectively, were not significantly different (p gt 0.05) despite having only a single failure (total cost 162,666) in the A-C group. Similarly, mean pharmacy costs of 1411 and 1604, respectively, were not significantly different (p gt 0.05). Conclusions: Hospital costs for infected patients with penetrating abdominal trauma exceed those of noninfected patients by 5-fold. Despite a lower infection rate in the A-C group, neither hospital nor pharmacy costs were significantly different compared with those in the G-C group.


PMID: 8888092

DOI: 10.1002/j.1875-9114.1996.tb03014.x

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