Guay D R
Section of Clinical Pharmacology, St. Paul-Ramsey Medical Center, MN 55101, USA.
Pharmacoeconomics. 1995 Dec;8(6):491-512. doi: 10.2165/00019053-199508060-00005.
Selection of macrolide antibiotics for formulary addition can be a difficult task, with the increasing availability of new agents as well as the numerous differences in pharmacokinetic and pharmacodynamic properties of available agents. Nonetheless, appropriate evaluation of the important characteristics of macrolide antibiotics should allow selection of the most cost-effective agents for formulary addition. Most importantly, differences in antimicrobial activity and efficacy, product formulation, tolerability and cost should be carefully considered when making formulary decisions. Notably, evidence from in vitro studies and clinical trials indicate differences between the macrolide antibiotics, especially in the management of a variety of opportunistic infections in immunocompromised patients. For selected clinical situations, it may be important to select an effective agent available in both oral and intravenous formulations, especially in severe pneumonia caused by Legionella spp. In addition, the availability of generic formulations should be considered for its potential to reduce cost. Comparative drug costs, as well as costs associated with noncompliance, should also be evaluated carefully. Dosage regimens should also be considered, as shorter durations of therapy and less frequent dose administration may lead to increased compliance and thereby improved effectiveness and economic efficiency.
选择添加到处方集的大环内酯类抗生素可能是一项艰巨的任务，因为新药物越来越多，而且现有药物的药代动力学和药效学特性存在诸多差异。尽管如此，对大环内酯类抗生素的重要特性进行适当评估应有助于选择最具成本效益的药物添加到处方集中。最重要的是，在做出处方集决策时，应仔细考虑抗菌活性和疗效、产品剂型、耐受性和成本等方面的差异。值得注意的是，体外研究和临床试验的证据表明大环内酯类抗生素之间存在差异，尤其是在免疫功能低下患者的各种机会性感染管理方面。对于某些临床情况，选择口服和静脉制剂都可用的有效药物可能很重要，特别是在由军团菌属引起的严重肺炎中。此外，应考虑通用剂型的可用性，因为其有可能降低成本。还应仔细评估药物的比较成本以及与不依从性相关的成本。还应考虑给药方案，因为较短的治疗时间和较少的给药频率可能会提高依从性，从而提高有效性和经济效益。
