Codina C, Miró J M, Tuset M, Claramonte J, Gomar C, Gotsens R, Gómez B, Suárez S, Abellana R, Ascaso C, Cartaña R, Rodríguez E, Asenjo M, Carné X, Trilla A, Marco F, Gómez J, Brunet M, Pomar J L, Gatell J M, Ribas J
Servicio de Farmacia, Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS (Instituto de Investigaciones Biomédicas August Pi i Sunyer).
Med Clin (Barc). 2000;114 Suppl 3:54-61.
To assess the economical impact of vancomycin use versus teicoplanin use as antibiotic prophylaxis for patients undergoing cardiac surgery for valve replacement (VR) and coronary artery by-pass (CABS) procedures.
This is an ancillary cost minimization analysis of a double blinded, parallel groups, randomised clinical trial (RCT), with the main objective of comparing the safety and efficacy of these antibiotics. 500 patients were included in the study; 267 in the CABS group and 233 in the VR group. The CABS patients received 1 g vancomicin or 400 mg teicoplanin, plus 150 mg netilmicin. The VR group received a second dose of each drug after extracorporeal circulation. In order to calculate the costs we considered the direct cost of the drug, the i.v. mix and the administration costs, together with personnel and structure costs. We considered two different situations: the administration of drugs within the surgical room theatre and in the medical ward.
The demographic data of both groups were comparable. The frequency of severe adverse drug reactions (ADR) were similar (0.4%) in both groups, as well as the post-operative infection rates (8.6%). Differences were seen in the frequencies of low severity ADRs: 20.4% in the vancomycin group and 1.6% in the teicoplanin group. When the antibiotics were administered in the surgical room, among CABS patients the costs were 8,265 pts. for the teicoplanin group and 12,005 pts. for the vancomycin group; while among VR patients, costs were respectively 11,661 pts. and 14,528 pts. Administration costs of teicoplanin and vancomycin within a medical ward setting, however, the costs were 6,740 pts. and 2,809 pts. for CABS patients, and 5,308 pts. and 10,140 pts. for VR patients, respectively.
The costs of antibiotic prophylaxis among cardiac surgery patients heavily depends on the setting and circumstances of drug administration. The minimization cost analysis indicates that teicoplanin is the most cost-effective option if the drug is administered within the surgical area, while vancomycin is the less costly option when administered within the medical ward. However, if the second option is to be chosen, it is necessary to assure the right plasmatic drug levels of the antibiotic at the beginning of the surgical procedure.
评估万古霉素与替考拉宁作为抗生素预防用药，用于接受心脏瓣膜置换术（VR）和冠状动脉搭桥术（CABS）的心脏手术患者的经济影响。
这是一项对双盲、平行组随机临床试验（RCT）的辅助成本最小化分析，主要目的是比较这些抗生素的安全性和有效性。500名患者纳入研究；CABS组267例，VR组233例。CABS患者接受1g万古霉素或400mg替考拉宁，加150mg奈替米星。VR组在体外循环后接受每种药物的第二剂。为了计算成本，我们考虑了药物的直接成本、静脉混合成本和给药成本，以及人员和结构成本。我们考虑了两种不同情况：在手术室和病房给药。
两组的人口统计学数据具有可比性。两组严重药物不良反应（ADR）的发生率相似（0.4%），术后感染率也相似（8.6%）。低严重程度ADR的发生率存在差异：万古霉素组为20.4%，替考拉宁组为1.6%。当在手术室给药时，CABS患者中，替考拉宁组的成本为8265点，万古霉素组为12,005点；而VR患者中，成本分别为11,661点和14,528点。然而，在病房环境中替考拉宁和万古霉素的给药成本，CABS患者分别为,6740点和2809点，VR患者分别为5308点和10,140点。
心脏手术患者抗生素预防的成本在很大程度上取决于给药的环境和情况。成本最小化分析表明，如果在手术区域给药，替考拉宁是最具成本效益的选择，而在病房给药时，万古霉素是成本较低的选择。然而，如果选择第二种方案，有必要在手术开始时确保抗生素的血浆药物水平合适。
