, Volume 38, Issue 6, pp 479–482 | Cite as

How much money can be saved by applying intravenous antibiotics once instead of several times a day?

  • D. Mertz
  • H. Plagge
  • S. Bassetti
  • M. Battegay
  • A. F. WidmerEmail author
Brief Report



The preparation, administration and monitoring of intravenous (IV) applications are time consuming and require human resources. We estimated the potential time and cost savings by replacing antibiotics given 3–4 times daily with antibiotics with similar spectrum and efficacy given once daily.


The savings of indirect costs were estimated based on the antibiotic consumption data of a two-year period (i.e. 2007 and 2008), a nurse’s mean workload per application and the average nurse’s salary in Switzerland.


The consumption of IV antibiotics in 2007 and 2008 at the University Hospital of Basel was 29.0 and 32.2 defined daily doses (DDD) per 100 patient days, respectively. Nurses spent an estimated 13,786 h on the application of the estimated 82,715 does of IV antibiotics. A total of 56,404 applications or nursing staff time costs of 338,436 Swiss Francs (CHF; 236,669 €), equal to 16% of the overall costs spent on purchasing antibiotics in the year 2008, may have been saved by switching multiple-dose antibiotics to a hypothetical once-daily antibiotic. Including disposable materials, 21% or 456,884 CHF (319,499 €) could be saved annually (purchase costs not taken into account).


We found a potential cost saving of 21% of the purchase costs in a 750-bed institution. Hence, indirect costs should be included in the calculation of the total cost for the application of broad-spectrum IV antibiotics. Switching from a 3–4 times daily application to a once-daily antibiotic should be considered if a once-daily antibiotic is deemed equally effective and has a similar spectrum.


Antibiotics Cost saving Once daily Administration Indirect costs 



This work was supported by an unrestricted grant from Merck Sharp & Dohme-Chibret (MSD) AG, Switzerland. The study sponsor did not participate in the study design, data analysis, collection, data interpretation or in the decision to submit this article for publication.

Conflict of interest



  1. 1.
    van Zanten AR, Engelfriet PM, van Dillen K, van Veen M, Nuijten MJ, Polderman KH. Importance of nondrug costs of intravenous antibiotic therapy. Crit Care. 2003;7:R184–90.CrossRefPubMedGoogle Scholar
  2. 2.
    Flynn E, Marciniak A, Barbabietola G, Oppenheim BA, Roberts C, Barker K. A multi-centre comparison of nursing staff time required for the preparation and administration of liposomal amphotericin B and amphotericin B deoxycholate vs. voriconazole. J Clin Nurs. 2009;18:1168–79.CrossRefPubMedGoogle Scholar
  3. 3.
    Mertz D, Koller M, Haller P, Lampert ML, Plagge H, Hug B, Koch G, Battegay M, Flückiger U, Bassetti S. Outcomes of early switching from intravenous to oral antibiotics on medical wards. J Antimicrob Chemother. 2009;64:188–99.CrossRefPubMedGoogle Scholar
  4. 4.
    Tice AD, Turpin RS, Hoey CT, Lipsky BA, Wu J, Abramson MA. Comparative costs of ertapenem and piperacillin-tazobactam in the treatment of diabetic foot infections. Am J Health Syst Pharm. 2007;64:1080–6.PubMedGoogle Scholar
  5. 5.
    Clay PG, Graham MR, Lindsey CC, Lamp KC, Freeman C, Glaros A. Clinical efficacy, tolerability, and cost savings associated with the use of open-label metronidazole plus ceftriaxone once daily compared with ticarcillin/clavulanate every 6 hours as empiric treatment for diabetic lower-extremity infections in older males. Am J Geriatr Pharmacother. 2004;2:181–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Tice AD, Hoaglund PA, Nolet B, McKinnon PS, Mozaffari E. Cost perspectives for outpatient intravenous antimicrobial therapy. Pharmacotherapy. 2002;22:63S–70S.CrossRefPubMedGoogle Scholar
  7. 7.
    Tice AD. Ertapenem: a new opportunity for outpatient parenteral antimicrobial therapy. J Antimicrob Chemother. 2004;53:ii83–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Wirtz V, Taxis K, Barber ND. An observational study of intravenous medication errors in the United Kingdom and in Germany. Pharm World Sci. 2003;25:104–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162:1897–903.CrossRefPubMedGoogle Scholar
  10. 10.
    Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.CrossRefPubMedGoogle Scholar

Copyright information

© Urban & Vogel 2010

Authors and Affiliations

  • D. Mertz
    • 1
  • H. Plagge
    • 2
  • S. Bassetti
    • 1
    • 3
  • M. Battegay
    • 1
  • A. F. Widmer
    • 1
    Email author
  1. 1.Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
  2. 2.Hospital PharmacyUniversity Hospital BaselBaselSwitzerland
  3. 3.Department of Internal MedicineKantonsspital OltenOltenSwitzerland

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