Cooke J, Cairns C J, Tillotson G S, Conner S, Lewin S K, Nicholls J, Tredree R L, Willis J V, Hitchings C R
General Infirmary, Leeds.
Ann Pharmacother. 1993 Jun;27(6):785-9. doi: 10.1177/106002809302700621.
To examine the use of oral ciprofloxacin and parenteral antimicrobials in the treatment of acute infection (respiratory tract, urinary tract, blood) in hospitalized patients, with particular reference to severity of infection, outcome, and associated economic implications of each treatment.
A prospective, multicenter comparative audit was conducted in the UK over an 18-month period. The audit was undertaken by clinical pharmacists who reviewed the antimicrobial treatment of patients with infective episodes, who were receiving or could have received oral therapy.
Clinical pharmacists who collated the data all are employed in teaching hospitals.
Patients were identified for analysis by their type of infection, severity of illness, antimicrobial prescribed, route of administration, and response to therapy. Additionally, data on costs of the antimicrobials prescribed and the supplementary costs of drug administration were calculated.
Four hundred eighty-five patients were enrolled for analysis; 208 of the patients had respiratory tract infection, 112 had urinary tract infection, 138 had septicemia, and 27 had mixed infections. Sepsis scores were applied to 152 patients receiving oral ciprofloxacin and 333 patients receiving parenteral antimicrobials and yielded mean scores of 5.9 (SD 3.1, range 1-13) and 8.7 (SD 4.2, range 1-22), respectively. Of 485 patients, 188 were paired according to sepsis score results and route of administration. Resolution occurred in 133 patients (79 receiving oral and 54 receiving parenteral therapy), further therapy was required in 49 (11 oral and 38 parenteral), and treatment was withdrawn in 6 (4 oral and 2 parenteral). Microbiologic assessment yielded positive results in 227 patients (47 percent). Drug acquisition costs (based on 1 UK pound = 1.80 US $) per course of treatment were $47.23 (SD $38.32, range 5.40-218.70) for the oral group and $173.70 (SD 209.77, range 2.11-1021.40) for the parenteral group. Overall costs for treatment courses were $74.00 (SD $52.81, range 8.10-309.17) and $305.59 (SD $304.70, range 14.69-1345.00) for the two groups, respectively (p < 0.001).
This study suggest that, in patients with moderate infective episodes, oral ciprofloxacin may reduce overall treatment costs compared with the use of parenteral antimicrobial agents.
研究口服环丙沙星和胃肠外抗菌药物在住院患者急性感染（呼吸道、泌尿道、血液感染）治疗中的应用，尤其涉及感染的严重程度、治疗结果以及每种治疗方法相关的经济影响。
在英国进行了一项为期18个月的前瞻性多中心对比审核。审核由临床药师进行，他们对正在接受或本可接受口服治疗的感染性疾病患者的抗菌治疗进行了审查。
收集数据的临床药师均受雇于教学医院。
根据感染类型、疾病严重程度、所开抗菌药物、给药途径和治疗反应确定患者进行分析。此外，还计算了所开抗菌药物的成本以及药物给药的补充成本。
485例患者纳入分析；其中208例患有呼吸道感染，112例患有泌尿道感染，138例患有败血症，27例患有混合感染。对152例接受口服环丙沙星治疗的患者和333例接受胃肠外抗菌药物治疗的患者应用了脓毒症评分，平均评分分别为5.9（标准差3.1，范围1 - 13）和8.7（标准差4.2，范围1 - 22）。在485例患者中，根据脓毒症评分结果和给药途径配对了188例。133例患者病情得到缓解（79例接受口服治疗，54例接受胃肠外治疗），49例（11例口服，38例胃肠外）需要进一步治疗，6例（4例口服，2例胃肠外）停止治疗。微生物学评估在227例患者（47%）中得到阳性结果。口服组每疗程的药物购置成本（基于1英镑 = 1.80美元）为47.23美元（标准差38.32美元，范围5.40 - 218.70美元），胃肠外组为173.70美元（标准差209.77美元，范围2.11 - 1021.40美元）。两组治疗疗程的总成本分别为74.00美元（标准差52.81美元，范围8.10 - 309.17美元）和305.59美元（标准差304.70美元，范围14.69 - 1345.00美元）（p < 0.001）。
本研究表明，对于中度感染性疾病患者，与使用胃肠外抗菌药物相比，口服环丙沙星可能降低总体治疗成本。
