Skip to main content
SpringerLink
Log in

Cost-effectiveness of ceftazidime or imipenem/cilastatin versus ceftriaxone+aminoglycoside in the treatment of febrile episodes in neutropenic cancer patients in Germany

  • Clinical and Epidemiological Studies
  • Originalia
  • Published:
Infection Aims and scope Submit manuscript

Summary

A three-pronged cost-effectivess analysis of the treatment of febrile episodes in neutropenic cancer patients was conducted. It included a review of 37 randomized, controlled studies in the MEDLINE and EMBASE databases (1980–1996). Clinical outcomes as well as costs of treatment with imipenem/cilastatin, ceftazidime and ceftriaxone+aminoglycoside were compared. Primary therapy and modification, respectively, were successful in 62 and 27% of patients treated with imipenem/cilastatin, in 56 and 31% with ceftazidime and in 41 and 13% with ceftriaxone+aminoglycoside. From the perspective of a 1,800-bed teaching hospital, the average overall cost per successfully treated patient was DM 7,475 with imipenem/cilastatin, DM 7,810 with ceftazidime and DM 8,963 with ceftriaxone+netilmicin (DM 1=USD 0.56; 7/97). The costs for the German national economy were imipenem/cilastatin DM 23,828, ceftazidime DM 24,985 and ceftriaxone+netilmicin DM 29,838.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hughes, W. T., Armstrong, D., Bodey, G. P., Feld, R., Mandell, L., Meyers, J. D., Pizzo, P. A., Schimpff, S. C., Shenep, J. L., Wade, J. D., Young, L. S., Yow, M.D. from the Infectious Diseases Society of America: Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. J. Infect. Dis. 161 (1990) 381–396.

    PubMed  CAS  Google Scholar 

  2. 1997 Drug Topics Red Book. Medical Economics Company, Inc., Montvale, 1997.

  3. Herbrecht, R., Blaise, D., Espinouse, D., Leblond, V., Sadoun, A., Sauvage, C., Cordonnier, C., Minozzi, C.: Isepamicin once daily plus ceftriaxone versus amikacin plus ceftriaxone in febrile neutropenic patients. J. Chemother. 7 (Suppl. 2) (1995) 103–110.

    PubMed  CAS  Google Scholar 

  4. Liu, C. Y., Wang, F. D.: A comparative study of ceftriaxone plus amikacin, ceftazidime plus amikacin and imipenem/cilastatin in the empiric therapy of febrile granulocytopenic cancer patients. Chemotherapy 35 (Suppl. 2) (1989) 16–22.

    Article  PubMed  Google Scholar 

  5. Yataganas, X., Rombos, Y., Vayopoulos, G., Meletis, J., Avlami, A.: Randomized clinical trial comparing ceftriaxone/amikacin versus ceftazidime/amikacin as initial therapy of febrile episodes in neutropenic patients. Chemotherapy 37 (1991) 376–381.

    PubMed  CAS  Google Scholar 

  6. Au, E., Tow, A., Allen, D. M., Ang, P. T.: Randomised study comparing imipenem/cilastatin to ceftriaxone plus gentamicin in cancer chemotherapy-induced neutropenic fever. Ann. Acad. Med. Singapore 23 (1994) 819–822.

    PubMed  CAS  Google Scholar 

  7. The International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer: Efficacy and toxicity of single daily doses of amikacin and ceftriaxone versus multiple daily doses of amikacin and ceftazidime for infection in patients with cancer and granulocytopenia. Ann. Intern. Med. 119 (1993) 584–593.

    Google Scholar 

  8. Platzeck, C., König, H. J., Manger, B.: Effektivität verschiedener Doppel-Betalaktam- und Betalaktam/Aminoglykosid-Kombinationen bei der Initialtherapie neutropenischer Patienten mit Fieber. Zeitschrift für antimikrobielle antineoplastische Chemotherapie 10 (1992) 55–62.

    Google Scholar 

  9. Aparicio, J., Oltra, A., Llorca, C., Montalar, J., Herranz, C., Gomez-Codina, J., Pastor, M., Munarriz, B.: Randomised comparison of ceftazidime and imipenem as initial monotherapy for febrile episodes in neutropenic cancer patients. Eur. J. Cancer 32A (1996) 1739–1743.

    Article  PubMed  CAS  Google Scholar 

  10. De Pauw, B., Williams, K., de Neeff, J., Bothof, T., de Witte, T., Holdrinet, R., Haanem, C. A.: A randomized prospective study of ceftazidime versus ceftazidime plus flucloxacillin in the empiric treatment of febrile episodes in severely neutropenic patients. Antimicrob. Agents Chemother 28 (1985) 824–828.

    PubMed  Google Scholar 

  11. De Pauw, B. E., Deresinski, S. C., Feld, R., Lane-Allman, E. F., Donnelly, J. P.: Ceftazidime compared with piperacillin and tobramycin for the empiric treatment of fever in neutropenic patients with cancer. A multicenter randomized trial. Ann. Intern Med. 120 (1994) 834–844.

    PubMed  Google Scholar 

  12. Donnelly, J. P., Marcus, R. E., Goldman, J. M., Cohen, J., Worsley, A. M., Catovsky, D., Darrell, J. H., Want, S. V., Galton, D. A. G.: Ceftazidime as first-line therapy for fever in acute leukaemia. J. Infect. 11 (1985) 205–215.

    Article  PubMed  CAS  Google Scholar 

  13. Engervall, P., Gunther, G., Ljungman, P., Lönnqvist, B., Hast, R., Stiernstedt, G., Kalin, M., Ringertz, S., Bjölkholm, M.: Trimethoprim-sulfamethoxazole plus amikacin versus ceftazidime monotherapy as empirical treatment in patients with neutropenia and fever. Scand. J. Infect. Dis. 28 (1996) 297–303.

    PubMed  CAS  Google Scholar 

  14. Freifeld, A. G., Walsh, T., Marshall, D., Gress, J., Steinberg, S. M., Hathorn, J., Rubin, M., Jarosinski, P., Gill, V., Young, R. C., Pizzo, P. A.: Monotherapy for fever and neutropenia in cancer patients: a randomized comparison of ceftazidime versus imipenem. J. Clin. Oncol. 13 (1995) 165–176.

    PubMed  CAS  Google Scholar 

  15. Liang, R., Yung, R., Chiu, E., Chau, P. Y., Chan, T. K., Lam, W. K., Todd, D.: Ceftazidime versus imipenem-cilastatin as initial monotherapy for febrile neutropenic patients. Antimicrob. Agents Chemother. 34 (1990) 1336–1341.

    PubMed  CAS  Google Scholar 

  16. Novakova, I., Donnelly, P., De Pauw, B.: Amikacin plus piperacillin versus ceftazidime as initial therapy in granulocytopenic patients with presumed bacteremia. Scand. J. Infect. Dis. 22 (1990) 705–711.

    PubMed  CAS  Google Scholar 

  17. Novakova, I., Donnelly, J. P., De Pauw, B.: Ceftazidime as monotherapy or combined with teicoplanin for initial empiric treatment of presumed bacteremia in febrile granulocytopenic patients. Antimicrob. Agents Chemother. 35 (1991) 672–678.

    PubMed  CAS  Google Scholar 

  18. Novakova, I., Donnelly, J. P., De Pauw, B.: Ceftazidime with or without amikacin for the empiric treatment of localized infections in febrile, granulocytopenic patients. Ann. Hematol. 63 (1991) 195–200.

    Article  PubMed  CAS  Google Scholar 

  19. Pizzo, P. A., Hathorn, J. W., Hiemenz, J., Browne, M., Commern, J., Cotton, D., Gress, J., Longo, D., Marshall, D., McKnight, J., Rubin, M., Skelton, J., Thaler, M., Wesley, R.: A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N. Engl. J. Med. 315 (1986) 552–558.

    Article  PubMed  CAS  Google Scholar 

  20. Ramphal, R., Bolger, M., Oblon, D. J., Sherertz, R. J., Malone, J. D., Rand, K. H., Gilliom, M., Shands, J. W., Kramer, B. S.: Vancomycin is not an essential component of the initial empiric treatment regimen for febrile neutropenic patients receiving ceftazidime: a randomized prospective study. Antimicrob. Agents Chemother. 36 (1992) 1062–1067.

    PubMed  CAS  Google Scholar 

  21. Verghagen, C. S., de Pauw, B., de Witte, T., Janssen, J., Williams, K., de Mulder, P., Bothof, T.: Randomized prospective study of ceftazidime versus ceftazidime plus cephalothin in empiric treatment of febrile episodes in severly neutropenic patients. Antimicrob. Agents Chemother. 31 (1987) 191–196.

    Google Scholar 

  22. Bayston, K. F., Want, S., Cohen, J.: A prospective, randomized comparison of ceftazidime and ciprofloxacin as initial empiric therapy in neutropenic patients with fever. Am. J. Med. 87 (1989) 269S-273S.

    Article  PubMed  CAS  Google Scholar 

  23. De Pauw, B. E., Kauw, F., Muytjens, H., Wiliams, K. J., Bothof, T.: Randomized study of ceftazidime versus gentamicin plus cefotaxime for infections in severe granulocytopenic patients. J. Antimicrob. Chemother. 12 (Suppl. A) (1983) 93–99.

    PubMed  Google Scholar 

  24. Fainstein, V., Bodey, G. P., Elting, L., Bolivar, R., Keating, M. J., McCredie, K. B., Valdivieso, M.: A randomized study of ceftazidime compared to ceftazidime and tobramycin for the treatment of infections in cancer patients. J. Antimicrob. Chemother. 12 (Suppl. A) (1983) 101–110.

    PubMed  Google Scholar 

  25. Kramer, B. S., Ramphal, R., Rand, K. H.: Randomized comparison between two ceftazidime-containing regimens and cephalothin-gentamicin-carbenicillin in febrile granulocytopenic cancer patients. Antimicrob. Agents Chemother. 30 (1986) 64–68.

    PubMed  CAS  Google Scholar 

  26. Rolston, K. V., Berkey, P., Bodey, G. P., Anaissie, E. J., Khardori, N. M., Joshi, J. H., Keating, M. J., Holmes, F. A., Cabanillas, F. F., Elting, L.: A comparison of imipenem to ceftazidime with or without amikacin as empiric therapy in febrile neutropenic patients. Arch. Intern. Med. 152 (1992) 283–291.

    Article  PubMed  CAS  Google Scholar 

  27. The Meropenem Study Group of Leuven, London and Nijmengen: Equivalent efficacies of meropenem and ceftazidime as empirical monotherapy of febrile neutropenic patients. J. Antimicrob. Chemother. 36 (1995) 185–200.

    Article  Google Scholar 

  28. Miller, J. A., Butler, T., Beveridge, R. A., Kales, A. N., Binder, R. A., Smith, L. J., Ueno, W. M., Milkovich, G., Goldwater, S., Marion, A., Eron, L., Mangi, R., Byrnes, C. A., Liss, C., Pashko, S.: Efficacy and tolerability of imipenem-cilastatin versus ceftazidime plus tobramycin as empiric therapy of presumed bacterial infection in neutropenic cancer patients. Clin. Ther. 15 (1993) 486–499.

    PubMed  CAS  Google Scholar 

  29. Mortimer, J., Miller, S., Black, D., Kwok, K., Kirby, M. K.: Comparison of cefoperazone and mezlocillin with imipenem as empiric therapy in febrile neutropenic cancer patients. Am. J. Med. 85 (1988) 17–20.

    Article  PubMed  CAS  Google Scholar 

  30. Mortimer, J. E., Black, D. W., Fijalka, S.: Comparison of cefoperazone and mezlocillin with imipenem/cilastatin in febrile neutropenic patients with cancer. Cur. Ther. Res. 49 (1991) 701–710.

    Google Scholar 

  31. Cornelissen, J. J., de Graeff, A., Verdonck, L. F., Brander, T., Rozenberg-Arska, M., Verhoef, J., Dekker, A. W.: Imipenem versus gentamicin combined with either cefuroxime or cephalothin as initial therapy for febrile neutropenic patients. Antimicrob. Agents Chemother. 36 (1992) 801–807.

    PubMed  CAS  Google Scholar 

  32. Kojima, A., Shinkai, T., Soejima, Y., Okamoto, H., Eguchi, K., Sasaki, Y., Tamura, T., Oshita, F., Ohe, P., Saijo, N.: A randomized prospective study of imipenem-cilastatin with or without amikacin as an empirical antibiotic treatment for febrile neutropenic patients. Am. J. Clin. Oncol. 17 (1994) 400–404.

    Article  PubMed  CAS  Google Scholar 

  33. Leyland, M. J., Bayston, K. F., Cohen, J., Warren, R., Newland, A. C., Bint, A. J., Cefai, C., White, D. G., Murray, S. A., Bareford, D., Deaney, N. B.: A comparative study of imipenem versus piperacillin plus gentamicin in the initial management of febrile neutropenic patients with haematological malignancies. J. Antimicrob. Chemother. 30 (1992) 843–854.

    Article  PubMed  CAS  Google Scholar 

  34. Matsui, K., Masuda, N., Takada, M., Kusunoki, Y., Fukuoka, M.: A randomized trial comparing imipenem/cilastatin alone with latamoxef plus tobramycin in febrile neutropenic patients with lung cancer. Jpn. J. Clin. Oncol. 21 (1991) 428–434.

    PubMed  CAS  Google Scholar 

  35. Winston, D. J., Ho, W. G., Bruckner, D. A., Champlin, R. E.: Betalactam antibiotic therapy in febrile granulocytopenic patients. A randomized trial comparing cefoperazone plus piperacillin, ceftazidime plus piperacillin, and imipenem alone. Ann. Intern. Med. 115 (1991) 849–859.

    PubMed  CAS  Google Scholar 

  36. Leese, B.: The costs of treating febrile neutropenia in six U.K. hospitals. Eur. J. Cancer 29A (1993) S15-S18.

    Article  PubMed  Google Scholar 

  37. Winston, D. J., Ho, W. G., Bruckner, D. A.: Beta-lactam antibiotic therapy in febrile granulocytopenic patients. A randomized trial comparing cefoperazone plus piperacillin, ceftazidime plus piperacillin, and imipenem alone. Ann. Intern. Med. 115 (1991) 849–859.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Umweltmedizin und Krankenhaushygiene, Universitätskliniken Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany

    E. S. Dietrich,  E. Patz,  U. Frank &  F. D. Daschner

Authors
  1. E. S. Dietrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Patz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Frank
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. D. Daschner
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dietrich, E.S., Patz, E., Frank, U. et al. Cost-effectiveness of ceftazidime or imipenem/cilastatin versus ceftriaxone+aminoglycoside in the treatment of febrile episodes in neutropenic cancer patients in Germany. Infection 27, 23–27 (1999). https://doi.org/10.1007/BF02565166

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02565166

Keywords

Search

Navigation