Cost considerations in oral antibiotic therapy

The total cost of antibiotic treatment may be computed from basic treatment and indirect costs. Basic treatment costs represent the product of the per-dose acquisition cost and the number of doses. Agents with a high per-dose acquisition cost and an infrequent (eg, once daily), short duration of therapy may have lower total costs than agents with a low per-dose acquisition cost and a high-frequency (eg, four times daily), long-duration regimen. Indirect cost reflects expenditures associated with noncompliance, treatment failure, adverse events, and drug interactions. These costs result, in turn, from additional office visits, treatment with alternative or additional medications, hospitalization, and lost productivity. Older agents, though likely to have lower acquisition costs, may have reduced efficacy against clinically important pathogens, side effects, drug interactions, and the requirement for multiple daily doses and long dosage regimens--factors that may increase the probability of poor outcome and the overall treatment cost. Newer broad-spectrum agents are effective and generally well tolerated and may have fewer drug interactions; however, most require long and relatively complex dosage regimens. These limitations increase the basic treatment cost and influence indirect costs through negative effects on patient compliance. Broad-spectrum antibiotics with low acquisition costs, simple dosing regimens, and relatively favorable safety and tolerability profiles may provide benefits in the treatment of common infections.