MONTREAL — Monotherapy with oral gemifloxacin for hospitalized patients with community-acquired pneumonia is a more cost-effective option than treatment with intravenous ceftriaxone followed by oral cefuroxime with or without a macrolide, a study has shown.
Gemifloxacin (Factive) is a synthetic fluoroquinolone antimicrobial agent with potent activity against most gram-negative and gram-positive organisms, such as Streptococcus pneumoniae (including multidrug-resistant S. pneumoniae), Haemophilus influenzae, and Moraxella catarrhalis. It is the most active of the pneumococcal quinolones.
A retrospective cost-benefit analysis of the two treatment regimens, which were compared in a randomized, open-label, multicenter investigation, showed that the mean cost per expected success—defined as an infection successfully treated—was $6,316 for the gemifloxacin therapy and $7,310 for the ceftriaxone regimen, Sujata M. Bhavnani, Pharm.D., reported in a poster presentation at an international conference on community-acquired pneumonia (CAP).
A total of 341 adults hospitalized with a clinical and radiologic diagnosis of CAP were enrolled in the multicenter study led by Hartmut Lode, M.D., of the Free University of Berlin. Of these patients, 169 were randomized to 320 mg oral gemifloxacin once daily for 7–14 days, while 172 received 2 g intravenous ceftriaxone for 1–7 days, followed by 500 mg oral cefuroxime twice daily for 1–13 days for a total of no more than 14 days. About 39% of the ceftriaxone patients received concomitant macrolide therapy.
The two regimens had similar efficacy, with response rates of 92.2% and 93.4%, respectively, for gemifloxacin and the ceftriaxone regimen. Both treatments were generally well tolerated, with similar types and frequencies of adverse events (Clin. Ther. 2002;24:1915–36).
To evaluate cost efficacy, Dr. Bhavnani, of the Institute for Clinical Pharmacodynamics at the Ordway Research Institute in Albany, N.Y., and colleagues analyzed the costs associated with antibiotic acquisition, antibiotic preparation, dispensing, and administration, as well as the treatment of antibiotic-related adverse events and clinical failures and hospital charges for both therapies.
Median length of stay was 8.0 days for the gemifloxacin group and 9.0 days for the ceftriaxone patients. For gemifloxacin and ceftriaxone, respectively, the mean costs of antibiotic acquisition were $201 and $501, while the combined costs for antibiotic preparation, dispensing, and administration and treatment of adverse events and clinical failures were $223 and $589. The mean hospital per diem costs were $5,823 and $6,828, respectively, Dr. Bhavnani said.
The findings confirm an important role for fluoroquinolones in therapy for CAP, “which could translate into real clinical and economic benefits,” Dr. Bhavnani noted at the conference, which was sponsored by the International Society of Chemotherapy.