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Pharmacy World and Science

, Volume 22, Issue 2, pp 53–58 | Cite as

Clinical and economic impact of a pharmacist‐intervention to promote sequential intravenous to oral clindamycin conversion

  • María J. Martínez
  • Angeles Freire
  • Isaura Rodriguez
  • Belén Bardán
  • Inés Castro
  • María T. Inaraja
  • Ana Ortega
  • Victor Del Campo
  • Luis E. Morano
  • José F. Garcia
Article

Abstract

A multicentre, prospective, controlled study compared the clinical efficacy, safety and economic impact of a pharmacist intervention to promote sequential intravenous to oral clindamycin conversion. A total of 473 patients receiving intravenous clindamycin for at least 72 hours were included in the study. Two groups were established: an intervention group (204 patients) in which an informative sheet recommending the sequential treatment was provided, and a control group (269 patients). Clindamycin was prescribed for respiratory infections in 38.9% and for prophylaxis in surgery in 25.4% of the patients (71% were contaminated surgery). No difference between groups regarding sex, infection severity, health status or clinical progress was observed. Both the step‐down treatments after 72 hours of intravenous clindamycin and the change to the oral route later on, were significantly increased with the intervention (p<0.001, p<0.001 respectively). No significant differences between both groups were found in the number of patients with adverse effects associated with the IV therapy, although the incidence tended to be lower in the intervention group (49/204 intervention versus 85/269 control, p=0.07). Compliance with the recommended clindamycin dosing regimen was significantly higher in the intervention group, in which 1.3 days reduction of intravenous therapy provided an average cost savings of PTA5246 (95%CI 2556‐7935) per treatment. A higher reduction of 1.7 days was achieved in those patients candidates for switch therapy on the third day of intravenous clindamycin. A sequential program with clindamycin may provide a cost‐effective alternative to conventional therapy and the introduction of an information sheet is a cost‐effective strategy to promote it.

Clindamycin Cost‐effectiveness Intravenous‐to‐oral step‐down Sequential therapy Switch therapy 

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References

  1. 1.
    Hitt CM, Nigthtingale CH, Quintiliani R, Nicolau DP. Streamlining antimicrobial therapy for lower respiratory tract infections. Clin Infect Dis 1997;24(Suppl 2):S231-7.Google Scholar
  2. 2.
    Zamin MT, Pitre MM, Conly JM. Development of an intravenous-to-oral route conversion program for antimicrobial therapy at a Canadian tertiary care health facility. Ann Pharmacother 1997;31:564-70.Google Scholar
  3. 3.
    MacGregor RR, Graziani AL. Oral Administration of Antibiotics: A Rational to the Parenteral Route. Clin Infect Dis 1997;24:457-67.Google Scholar
  4. 4.
    Przybylski KG, Rybak MJ, Martin PR, Weingarten CM, Zaran FK, Stevenson JG et al. A pharmacist-initiated program of intravenous to oral antibiotic conversion. Pharmacotherapy 1997;17:271-6.Google Scholar
  5. 5.
    Frighetto L, Nickoloff D, Martinusen M, Mamdani F, Jewelson P. Intravenous-to-oral stepdown program: four years of experience in a large teaching hospital. Ann Pharmacother 1992;26:1447-51.Google Scholar
  6. 6.
    De Haan RM, Metzler CM, Schellenberg D, Vandenbosch WD. Pharmacokinetic studies of clindamycin phosphate. J Clin Pharmacol 1973;18:190-209.Google Scholar
  7. 7.
    Black JR, Feinberg J, Murphy RL, Fads RJ, Carey J, Sattler FR. Clindamycin and primaquine as primary treatment for mild and moderately severe Pneumocystis carinii pneumonia in patients with AIDS. Eur J Clin Microbiol Infect Dis 1991;10:204-7.Google Scholar
  8. 8.
    Cunha BA. Intravenous-to-oral antibiotic switch therapy. Postgrad-Med 1997;101:111-2,115-8,122-3 passim.Google Scholar
  9. 9.
    Crombleholme WR, Schachter J, Ohm-Smith M, Luft J, Whidden R, Sweet RL. Efficacy of single-agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin. Am J Med 1989;87(Suppl 5 A):142-7s.Google Scholar
  10. 10.
    Gudiol F, Manresa F, Pallares R, Dorca J, Rifi G, Boada J, et al. Clindamycin vs penicillin for anaerobic lung infections. Arch Intern Med 1990;150:2525-9.Google Scholar
  11. 11.
    Thadepalli H, Mathai D, Scotti R, Bansal MB, Savage E. Ciprofloxacin monotherapy for acute pelvic infections: a comparison with clindamycin plus gentamicin. Obstet Gynecol 1991;78:696-707.Google Scholar
  12. 12.
    Flaherty JF, Gatti G, White J, Bubp J, Borin M, Gambertoglio JG. Protein binding of clindamycin in sera of patients with AIDS. Antimicrob Agents Chemother 1996;40:1134-8.Google Scholar
  13. 13.
    Gatti G, Flaherty JF, Bubp J, White J, Borin M, Gambertoglio JG. Comparative study of bioavailabilities and pharmacokinetics of clindamycin in healthy volunteers and patients with AIDS. Antimicrob Agents Chemother 1993;37:1137-43.Google Scholar
  14. 14.
    Vogel F. Sequential therapy in the hospital management of lower respiratory infections. Am J Med 1995;99(Suppl 6 B):14S-19S.Google Scholar
  15. 15.
    Mc Cabe WR, Jackson GG. Gram-negative bacteremia. Arch Intern Med 1962; 110:847-64.Google Scholar
  16. 16.
    Knaus WE, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease clasification system. Crit Care Med 1985;13:818-28.Google Scholar
  17. 17.
    Wacha H, Linder MM, Foldman V, Wesch G, Gundlach E, Steifesand RA. Mannheim peritonitis index-prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index. Theoret Surg 1987;1:69-77.Google Scholar
  18. 18.
    Elebute EA, Stoner HB. The grading of sepsis. Br J Surg 1983;70:29-31.Google Scholar
  19. 19.
    Frighetto L, Martinussen S, Mamdami F, Jeweson P. Assesment of ciprofloxacin use under the influence of a reserved antimicrobial program and parenteral-oral stepdown program at a major Canadian Hospital. Can J Hosp Pharm 1995;48:35-42.Google Scholar
  20. 20.
    Sanjurjo M, Requena T, Requena ME, Fernández I. Estimación de costes asociados a los fármacos en el ambito hospitalario. Propuesta de un modelo. Farmacoeconomía 1995;1:9-22.Google Scholar
  21. 21.
    Azanza JR, Cameán M, Cercós AC, Domínguez-Gil A, Escrivá J, Gobernado M, et al. Consenso sobre el diseño de un modelo farmacoeconómico Útil para la valoración de antibióticos parenterales de uso hospitalario. Farmacoeconomía 1997;3:35-49.Google Scholar
  22. 22.
    Paladino JA, Sperry HE, Backes JM, Gelber JA, Serrianne DJ, Cumbo TJ et al. Clinical and economic evaluation of oral ciprofloxacin following an abbreviated course of intravenous antibiotics. Am J Med 1991;15:462-70.Google Scholar
  23. 23.
    Ahkee S, Smith S, Newman D, Ritter W, Burke J, Ramirez JA. Early switch from intravenous to oral antibiotics in hospitalized patients with infections: a 6-month prospective study. Pharmacotherapy 1997;17:569-75.Google Scholar
  24. 24.
    Craig WA, Andes DR. Parenteral versus oral antibiotic therapy. Med Clin North Am 1995;79:497-508.Google Scholar
  25. 25.
    Cooke J, Cairns CJ, Tillotson GS, Conner S, Lewin SKM, Nicholls J, et al. Comparative clinical, microbiologic, and economic audit of the use of oral ciprofloxacin and parenteral antimicrobials. Ann Pharmacother 1993;27:785-9.Google Scholar
  26. 26.
    Solomkin JS, Reinhard HH, Dellinger EP, Bohnen JM, Rotstein OD, Vogel SB, et al. Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. The Intra-Abdominal Infection Study Group. Ann Surg 1996;223:303-15.Google Scholar
  27. 27.
    Malfair SC, Frighetto L, Nickoloff DM, Martinusen SM, Jewesson PJ. Evaluation of the use of cefuroxime and cefuroxime axetil in an intravenous-oral stepdown program. Ann Pharmacother 1996;30:337-42.Google Scholar
  28. 28.
    Reinke CM, Messick CR. Update on Clostridium difficile-induced colitis, part 1. Am J Hosp Pharm 1994;51:1771-81.Google Scholar
  29. 29.
    Pear SM, Williamson TH, Bettin KM, Gerding DN. Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Inter Med 1994;120:272-7.Google Scholar
  30. 30.
    Chin A, Gill MA, Ito MK, Yellin AE, Berne TV, Heseltine NR, et al. Cost analysis of two clindamycin dosing regimens. DICP Ann Pharmacother 1989;23:980-3.Google Scholar
  31. 31.
    Rovers JP, Ilersich AL, Einarson TR. Meta-analysis of parenteral clindamycin dosing regimens. Ann Pharmacother 1995;29:852-8.Google Scholar
  32. 32.
    Amodio-Groton M, Madu A, Madu CN, Briceland LL, Seligman M, McMaster P, et al. Sequential parenteral and oral ciprofloxacin regimen versus parenteral therapy for bacteremia: a pharmacoeconomic analysis. Ann Pharmacother 1996;30:596-602.Google Scholar
  33. 33.
    Ramirez JA, Srinath L, Ahkee S, Huang A, Raff MJ. Early swich from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia. Arch Inter Med 1995;155:1273-6.Google Scholar
  34. 34.
    Hendrickson JR, North DS. Pharmacoeconomic benefit of antibiotic step-down therapy: converting patients from intravenous ceftriaxone to oral cefpodoxime proxetil. Ann Pharmacother 1995;29:561-5.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • María J. Martínez
    • 1
  • Angeles Freire
    • 2
  • Isaura Rodriguez
    • 2
  • Belén Bardán
    • 2
  • Inés Castro
    • 3
  • María T. Inaraja
    • 3
  • Ana Ortega
    • 4
  • Victor Del Campo
    • 5
  • Luis E. Morano
    • 6
  • José F. Garcia
    • 7
  1. 1.Department of PharmacyMeixoeiro Hospital, Meixoeiro s/nVigo. PontevedraSpain
  2. 2.Department of PharmacyArquitecto Marcide HospitalFerrol. La CoruñaSpain
  3. 3.Department of PharmacyMeixoeiro Hospital, Meixoeiro s/nPontevedraSpain
  4. 4.Clínica Universitaria de NavarraNavarraSpain
  5. 5.Department of EpidemiologyMeixoeiro Hospital. Meixoeiro s/nVigo. PontevedraSpain
  6. 6.Department of Internal Medicine‐Infectious DiseasesMeixoeiro HospitalVigo. PontevedraSpain
  7. 7.Department of Internal Medicine‐Infectious DiseasesArquitecto Marcide HospitalLa CoruñaSpain

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