摘要:

With the implementation of prospective payment (e.g. diagnosis-related groups [DRGs] and cost containment efforts, physicians and pharmacists have had to reevaluate current drug delivery systems in the search for the least costly means of administering parenteral products. The following describes a three-phase approach to fully assess relative antibiotic cost and to assess economic efficiencies of intramuscular and intravenous administration of antibiotics. Relative costs of therapy consist of acquisition cost, administration cost and total cost of self-administration. Various intravenous administration systems are described, as are considerations for intramuscular administration. Comparisons are made using intravenous and intramuscular administrations of cefazolin, gentamicin, penicillin and imipenem. Using a ‘best case’ scenario, the intramuscular route was found to be up to one tenth the expense of the intravenous route in certain instances. Also, the intramuscular route may facilitate early discharge and self-administration in the home. Antibiotics available for intramuscular injection should therefore be considered as an economically efficient alternative to intravenous injections, in appropriate patie

ISSN:0009-3157    

DOI:10.1159/000238912

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Antibiotics can be administered parenterally to outpatients in order to achieve adequate serum levels to treat such infections as endocarditis, osteomyelitis and diabetic foot infections, and to eradicate such difficult-to-treat organisms as methicillin-resistant Staphylococcus aureus, cephalothin-resistant gram-negative bacilli and invasive fungal infections. At Intracare, a free-standing clinic for such therapy, 3,247 outpatients have been treated to date. Besides the type of infection, criteria for patient selection include improvement in the patient’s condition, a desire to leave the hospital, an adequate support structure at home, patient compliance and adequate insurance coverage. The most frequently treated infections have been osteomyelitis, followed by infection of skin and skin structure. Ceftriaxone and cefazolin are the two most frequently utilized antibiotics. The program at Intracare is used to examine such issues of quality assurance as patient compliance, therapeutic outcome, adverse events and patient satisfaction in this largely unregulated multibiUion dollar industry. It is likely that such infusion centers will evolve into protohospitals, day care centers for present-day medical-surgical patients not occupying intensive care bed

ISSN:0009-3157    

DOI:10.1159/000238914

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Since 1983, numerous studies have confirmed the efficacy of imipenem/cilastatin as monotherapy for polymicrobial and multiresistant infections. Doses range from 1 to 4 g/day, usually given in 3–4 intravenous infusions. Recently, a sustained-release, intramuscular formulation of imipenem/cilastatin sodium has been developed. Investigations in both animals and healthy human volunteers have shown that this formulation maintains plasma concentrations of imipenem above susceptibility breakpoints for nearly twice the duration provided by similar intravenous doses. Although peak concentrations are lower with the intramuscular formulation, current research suggests that the efficacy of β-lactam antibiotics is more closely related to the duration that levels are sustained above minimum inhibitory concentrations, rather than to the magnitude of peak concentrations over minimum inhibitory concentrations. Hence, the intramuscular formulation of imipenem/cilastatin sodium holds promise as an efficient, effective regimen in patients with serious infections of mild to moderate severi

ISSN:0009-3157    

DOI:10.1159/000238915

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

One hundred and two patients were enrolled in an open-label evaluation of intramuscular imipenem/cilastatin using doses of either 500 or 750 mg every 12 h in the treatment of mild to moderately severe skin and soft tissue infections. Seventy-four of 102 patients were clinically evaluable. Thirty-one patients had abscesses, 20 had cellulitis and 23 had wound infections. One hundred seventy-eight isolates were recovered from these 74 patients (average 2.4 isolates/patient). Sixty of 74 evaluable patients (82%) were cured; 12 of 74 (16%) were improved. Two patients failed to improve. Therapy was well tolerated. Adverse effects occurred in 8 patients. All of these effects were minor, and none required discontinuation of therapy. Eighty-two percent of patients reported no pain with injections. Therapy did not need to be interrupted or discontinued in the remaining 18% of patients reporting moderate local pain with injections. Peak and trough serum imipenem levels were measured in 15 patients receiving a 500-mg intramuscular dose of imipenem/cilastatin. The mean peak imipenem concentration in 15 patients was 10.7 μg/ml (range 3.3–17.8); the mean trough concentration was 2.1 μg/ml (range 0.8–4.9). The trough levels were higher than those found in healthy volunteers and may reflect the age and mild renal dysfunction in this group of treated patients. Imipenem/cilastatin used for mild or moderate skin and soft tissue infections was both efficacious and well tolerated. Intramuscular therapy with this agent offers advantages over intravenous therapy because of its long apparent half-life and pharmacokin

ISSN:0009-3157    

DOI:10.1159/000238916

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We evaluated the efficacy, patient and medical staff acceptance, and costs of intramuscular therapy with imipenem/cilastatin for mild to moderate upper reproductive tract infection in hospitalized women in an open study. Thirty-five patients were enrolled, and 29 successfully completed the protocol. Of these, 90% were satisfactorily treated with imipenem/cilastatin given intramuscularly. Twenty-eight of 29 subjects tolerated the intramuscular injections well, although 7 women noted mild to moderate discomfort during injection. All patients who had previously received intravenous therapy (24/29) stated that they preferred the intramuscular injections to continuation or reinitiation of intravenous treatment. Therapy with intramuscular imipenem/cilastatin (assuming a marketed price per gram of approximately $ 30) was associated with cost savings in comparison with other regimens offering similar antibacterial coverage. Initial care provider resistance to treatment with intramuscular imipenem/cilastatin was overcome due to patient satisfaction. Intramuscularly administered imipenem/cilastatin was effective, generally well tolerated, and resulted in cost saving. Intramuscular administration of imipenem/cilastatin may be a preferred antibiotic treatment in patients with mild to moderate infection due to susceptible microorganisms.

ISSN:0009-3157    

DOI:10.1159/000238917

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

An open-label prospective study was performed employing intramuscularly administered imipenem as an adjunct to surgery in 20 patients with acute cholecystitis and 24 patients with perforated or gangrenous appendicitis. Three (12.5%) septic failures occurred in appendicitis patients and 2 (10%) failures in cholecystitis patients. There were no deaths. Adverse effects were minor, and there was no toxicity. Although failures were not associated with in vitro resistance, Pseudomonas spp. were recovered from 2 of 3 appendicitis failures. Intramuscular imipenem appeared to be an effective single-drug antimicrobial when used as an adjunct to surgery in patients with acute cholecystitis or perforated appendicitis. It should be a more cost-effective alternative to the current multiple-drug therapy frequently employed in patients with intra-abdominal sepsis.

ISSN:0009-3157    

DOI:10.1159/000238918

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Multicenter noncomparative trials of intramuscular administration of imipenem/cilastatin for the treatment of a variety of infections requiring multiple-dose therapy are reviewed. Fourteen centers in the United States and 18 centers elsewhere participated in these studies. A total of 686 patients (461 evaluable) were treated worldwide. The severity of the infection was rated as moderate in 58.9%, mild in 37.2% and severe in 0.6%. The most common sites of infection were the skin and soft tissue (36.2%) and intra-abdominal (17.6%). Polymicrobial infections were relatively common (27%). Dosing regimens in evaluable patients were 500 mg every 12 h (45.1%), 750 mg every 12 h (36.2%) and 500 mg every 8 h (18.6%). The overall clinical outcome was favorable (clinical cure or improvement) for 95% or more of the evaluable patients with the various body system infections, except in gynecologic infections where 89% of the evaluable patients had a favorable outcome and for sepsis where the favorable outcome was 76%. Where data were available for analysis (skin and soft tissue infections) there was no difference in favorable clinical outcome among patients with moderate infection treated with 1.0 g/day (95% favorable) compared with 1.5g/day (94% favorable). The overall bacteriologic eradication rate was 91%. Clinical adverse effects were similar in type but less common in frequency than those noted in other studies with the intravenous formulation, with nausea, vomiting and diarrhea being most common; no instances of seizures or confusion were observed. The laboratory adverse effects were similar to those seen in other studies with the intravenous formulation, with increased liver enzyme values the most common. The intramuscular injection was well tolerated in 87% of the patients and moderately well tolerated in 6.6%. The efficacy and low incidence of side effects of the intramuscular formulation of imipenem/cilastatin are significant advantages in the cost-effective treatment of infections.

ISSN:0009-3157    

DOI:10.1159/000238919

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Imipenem is the broadest-spectrum antibiotic currently available but requires frequent intravenous dosing for efficacy. A recently formulated finely milled preparation can be given intramuscularly in small volumes and demonstrates kinetics favorable for 12-hourly intramuscular administration. The intramuscular imipenem formulation has been proven to be effective for mild to moderate infections of many body sites, as demonstrated by other papers in this symposium. The advantages of intramuscular administration include: less frequent dosing, avoidance of the complications of intravenous administration (phlebitis, bacteremia, fluid overload, nursing time), ability to use the drug in settings where intravenous administration is either undesirable or impossible and, surprising to medical personnel, greater patient satisfaction.

ISSN:0009-3157    

DOI:10.1159/000238920

出版商:S. Karger AG    

年代:1991

数据来源: Karger

ISSN:0009-3157    

DOI:10.1159/000238921

出版商:S. Karger AG    

年代:1991

数据来源: Karger

ISSN:0009-3157    

DOI:10.1159/000238922

出版商:S. Karger AG    

年代:1991

数据来源: Karger