Department of Pharmacy, Kobe University Hospital, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Department of Infection Control and Prevention, Kobe University Hospital, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Int J Clin Pharm. 2019 Dec;41(6):1611-1617. doi: 10.1007/s11096-019-00926-z. Epub 2019 Oct 25.
Background De-escalation therapy is recommended as an effective antibiotic treatment strategy for several infectious diseases. While there is limited evidence supporting its clinical and cost-effective outcomes in patients with community-acquired bacteremic pneumonia, there is no evidence in patients with nonbacteremic pneumonia. Objective This study aimed to evaluate the antibiotic costs in patients who did and did not receive de-escalation therapy, based on the 2017 Japanese guidelines for the management of community-acquired nonbacteremic pneumococcal pneumonia of the Japanese Respiratory Society (JRS). Setting Kobe university hospital, Japan. Methods A retrospective case series review including antibiotic use and length of hospital stay was conducted using the medical records from April 2008 to May 2019 at a university hospital in Japan. Main outcome measure Impact of antibiotic de-escalation therapy on the antibiotic costs. Results Among 55 patients who were eligible, the treating physicians de-escalated antibiotics in 28 (51%). The differences in the median length of hospital stay and the incidence of adverse drug reactions between the two groups were not statistically significant (p = 0.67 and 1.0, respectively). However, the median total antibiotic cost per infected patient in the de-escalated group was significantly lower than that in the non-de-escalated group [$269.8 ($195-$389) vs. $420.5 ($221-$799), p = 0.048]. Conclusion Antibiotic de-escalation based on the 2017 JRS guidelines leads to a reduction in total antibiotic costs for the management of community-acquired nonbacteremic pneumococcal pneumonia.
降阶梯疗法被推荐为治疗几种传染病的有效抗生素治疗策略。虽然有有限的证据支持社区获得性菌血症性肺炎患者的临床和成本效益结果，但在非菌血症性肺炎患者中没有证据。目的：本研究旨在根据日本呼吸学会（JRS）2017 年管理社区获得性非菌血症性肺炎的日本指南评估接受和未接受降阶梯治疗的患者的抗生素费用。地点：日本神户大学医院。方法：对 2008 年 4 月至 2019 年 5 月在日本一所大学医院的医疗记录进行了回顾性病例系列研究，包括抗生素使用和住院时间。主要观察指标：抗生素降阶梯治疗对抗生素费用的影响。结果：在 55 名符合条件的患者中，28 名（51%）治疗医生进行了抗生素降阶梯治疗。两组患者的中位住院时间和药物不良反应发生率差异无统计学意义（p=0.67 和 1.0）。然而，降阶梯组每个感染患者的中位总抗生素费用明显低于非降阶梯组[269.8（195-389）美元比 420.5（221-799）美元，p=0.048]。结论：根据 2017 年 JRS 指南进行的抗生素降阶梯治疗可降低社区获得性非菌血症性肺炎的总抗生素费用。
