Martinusen S, Chen D, Frighetto L, Bunz D, Stiver H G, Jewesson P J
Department of Pharmacy, Vancouver General Hospital, BC.
CMAJ. 1993 Apr 1;148(7):1161-9.
To determine whether (a) ceftizoxime can replace cefoxitin in the prevention and treatment of various infections in a major teaching hospital, (b) a previously applied two-stage intervention program is an effective method of instituting a therapeutic interchange of ceftizoxime for cefoxitin and (c) the replacement of cefoxitin with ceftizoxime results in a more cost-effective therapy.
Two-phase, open, sequential study.
Tertiary care teaching hospital.
One hundred patients who received cefoxitin during the 6 months immediately before the start of the interchange program (phase 1) and 100 who received ceftizoxime during the 6 months immediately after the start of the program (phase 2) were randomly selected.
The demographic characteristics of the two patient groups were similar except for sex (p < 0.05). The cefoxitin doses were usually given every 6 hours (in 33% of the cases) or every 8 hours (in 61%), whereas the ceftizoxime doses were usually given every 12 hours (in 98%). Prescriber distribution was stable throughout the study period, the Department of General Surgery being responsible for about 70% of the orders. Prophylactic indications accounted for over 60% of the treatment courses. The proportion of prophylactic treatment courses that resulted in a successful clinical outcome did not differ between the two groups (cefoxitin 92% and ceftizoxime 91%). Of the empiric or directed treatment courses clinical success or improvement was observed in 89% of the cefoxitin and 91% of the ceftizoxime recipients. Microbiologic eradication was seen in 65% of the cefoxitin and 90% of the ceftizoxime directed treatment courses. Pathogens isolated during therapy were similar in the two treatment groups. Diarrhea was the most common adverse effect, occurring in 8% of the cefoxitin and 10% of the ceftizoxime recipients; no Clostridium difficile or C.-difficile-producing toxin was identified in these patients. The ceftizoxime therapy was 36% less expensive than the cefoxitin therapy on average, and the annual savings was estimated to be $83,123. An estimated 5615 drug doses were avoided annually, for an additional savings of $24,875 in drug administration. Therefore, the total estimated annual cost savings resulting from this two-stage interchange program was $107,998. Given the cost of $4856 to implement and maintain the program, the estimated net savings for the first year was $103,142.
Ceftizoxime can replace cefoxitin in the prevention and treatment of various infections. The form of evaluation described herein is valuable when any formulary modification is being considered in a hospital.
确定（a）在一家大型教学医院中，头孢唑肟是否可替代头孢西丁用于预防和治疗各种感染；（b）先前应用的两阶段干预方案是否是将头孢唑肟替换头孢西丁进行治疗性替换的有效方法；以及（c）用头孢唑肟替代头孢西丁是否能带来更具成本效益的治疗。
两阶段、开放、序贯研究。
三级护理教学医院。
在换药计划开始前6个月内接受头孢西丁治疗的100名患者（第1阶段）以及在计划开始后6个月内接受头孢唑肟治疗的100名患者（第2阶段）被随机选取。
除性别外（p < 0.05），两组患者的人口统计学特征相似。头孢西丁剂量通常每6小时给药一次（33%的病例）或每8小时给药一次（61%），而头孢唑肟剂量通常每12小时给药一次（98%）。在整个研究期间，开方者分布稳定，普通外科负责约70%的医嘱。预防性指征占治疗疗程的60%以上。两组预防性治疗疗程中临床结局成功的比例无差异（头孢西丁92%，头孢唑肟91%）。在经验性或针对性治疗疗程中，头孢西丁接受者中89%观察到临床成功或改善，头孢唑肟接受者中91%观察到临床成功或改善。在头孢西丁针对性治疗疗程中65%实现了微生物清除，在头孢唑肟针对性治疗疗程中90%实现了微生物清除。两个治疗组在治疗期间分离出的病原体相似。腹泻是最常见的不良反应，头孢西丁接受者中8%出现腹泻，头孢唑肟接受者中10%出现腹泻；这些患者中未鉴定出艰难梭菌或产艰难梭菌毒素。头孢唑肟治疗平均比头孢西丁治疗便宜36%，估计每年节省83,123美元。估计每年可避免5615剂药物，在药物给药方面额外节省24,875美元。因此，这个两阶段换药计划估计每年总共节省成本107,998美元。考虑到实施和维持该计划的成本为4856美元，第一年估计净节省103,142美元。
头孢唑肟可替代头孢西丁用于预防和治疗各种感染。当医院考虑对处方集进行任何修改时，本文所述的评估形式很有价值。
