Young M, Plosker G L
Adis International Limited, Auckland, New Zealand.
Pharmacoeconomics. 2001;19(11):1135-75. doi: 10.2165/00019053-200119110-00006.
Piperacillin/tazobactam is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity against most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria. Piperacillin/tazobactam is effective and well-tolerated in patients with lower respiratory tract infections (LRTI), intra-abdominal infections, skin and soft tissue infections, and febrile neutropenia. In comparative clinical trials against various other antibacterial regimens, piperacillin/tazobactam has shown higher clinical success rates, particularly in the treatment of patients with intra-abdominal infections and febrile neutropenia. Cost analyses of piperacillin/tazobactam have been variable, in part, because of differences in specific costs included. Three US cost analyses found that piperacillin/tazobactam had lower total medical costs than clindamycin plus gentamicin or imipenem/cilastatin in intra-abdominal infections, and ticarcillin/ clavulanic acid in community-acquired pneumonia. Piperacillin/tazobactam plus amikacin had lower total costs than ceftazidime plus amikacin in another cost analysis of patients with febrile neutropenic episodes modelled in nine European countries. However, piperacillin/tazobactam plus tobramycin was more costly than ceftazidime plus tobramycin in hospital-acquired pneumonia in a US cost analysis. In cost-effectiveness analyses, all studies of intra-abdominal infections, pneumonia and febrile neutropenic episodes consistently reported lower costs per unit of effectiveness versus comparators. Piperacillin/tazobactam was dominant (greater efficacy and lower costs) versus imipenem/cilastatin in intra-abdominal infections and ceftriaxone, ciprofloxacin or meropenem in pneumonia. Piperacillin/tazobactam plus amikacin was dominant over ceftazidime plus amikacin in the treatment of febrile neutropenic episodes. In a cost-effectiveness analysis of skin and soft tissue infection, piperacillin/tazobactam had lower costs per successfully treated patient than ceftriaxone or cefotaxime, but a slightly higher cost-effectiveness ratio than amoxicillin/clavulanic acid. All cost-effectiveness analyses were based on decision-analytical models.
Piperacillin/tazobactam is likely to reduce overall treatment costs of moderate to severe bacterial infections by increasing initial treatment success, thereby reducing the length of hospital stay and the use of additional antibacterials. Piperacillin/tazobactam has shown clinical and economic advantages over standard antibacterial regimens in the treatment of intra-abdominal infections, LRTIs, febrile episodes in patients with neutropenia, and skin and soft tissue infections, although more complete published data are needed to confirm these results. Present data regarding clinical efficacy, bacterial resistance and costs would support the use of piperacillin/tazobactam as an empirical first-line option in moderate to severe bacterial infections.
哌拉西林/他唑巴坦是一种β-内酰胺/β-内酰胺酶抑制剂组合，对大多数革兰氏阳性和革兰氏阴性需氧菌及厌氧菌具有广谱抗菌活性。哌拉西林/他唑巴坦在治疗下呼吸道感染（LRTI）、腹腔内感染、皮肤及软组织感染和发热性中性粒细胞减少症患者时有效且耐受性良好。在针对各种其他抗菌方案的对比临床试验中，哌拉西林/他唑巴坦显示出更高的临床成功率，尤其是在治疗腹腔内感染和发热性中性粒细胞减少症患者时。哌拉西林/他唑巴坦的成本分析结果各不相同，部分原因在于所纳入的具体成本存在差异。三项美国成本分析发现，在腹腔内感染中，哌拉西林/他唑巴坦的总医疗成本低于克林霉素加庆大霉素或亚胺培南/西司他丁，在社区获得性肺炎中低于替卡西林/克拉维酸。在另一项针对九个欧洲国家发热性中性粒细胞减少症发作患者的成本分析中，哌拉西林/他唑巴坦加阿米卡星的总成本低于头孢他啶加阿米卡星。然而，在美国一项医院获得性肺炎的成本分析中，哌拉西林/他唑巴坦加妥布霉素的成本高于头孢他啶加妥布霉素。在成本效益分析中，所有关于腹腔内感染、肺炎和发热性中性粒细胞减少症发作的研究均一致报告，与对照药物相比，每单位疗效的成本更低。在腹腔内感染中，哌拉西林/他唑巴坦相对于亚胺培南/西司他丁占优势（疗效更高且成本更低），在肺炎中相对于头孢曲松、环丙沙星或美罗培南占优势。在治疗发热性中性粒细胞减少症发作时，哌拉西林/他唑巴坦加阿米卡星相对于头孢他啶加阿米卡星占优势。在一项皮肤及软组织感染的成本效益分析中，哌拉西林/他唑巴坦每成功治疗一名患者的成本低于头孢曲松或头孢噻肟，但成本效益比略高于阿莫西林/克拉维酸。所有成本效益分析均基于决策分析模型。
哌拉西林/他唑巴坦可能通过提高初始治疗成功率来降低中重度细菌感染的总体治疗成本，从而缩短住院时间并减少额外抗菌药物的使用。在治疗腹腔内感染、下呼吸道感染、中性粒细胞减少症患者的发热发作以及皮肤及软组织感染方面，哌拉西林/他唑巴坦已显示出相对于标准抗菌方案的临床和经济优势，尽管需要更完整的已发表数据来证实这些结果。目前关于临床疗效、细菌耐药性和成本的数据支持将哌拉西林/他唑巴坦用作中重度细菌感染的经验性一线用药选择。
