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The extended-spectrum penicillins: microbiologic, utilization, and cost review in a community hospital
Abstract:
The extended-spectrum penicillins have a similar spectrum of activity and clinical efficacy. The newer acylaminopenicillins (azlocillin, mezlocillin, piperacillin) offer several potential therapeutic advantages over the carboxypenicillins (carbenicillin, ticarcillin), but they are more expensive per gram. Literature reviews of these penicillins suggest that individual hospital susceptibility patterns and cost should guide selection of the most appropriate antibiotic for formulary addition. Consequently, the authors performed a microbiologic, utilization, and cost review of these antibiotics in a community hospital. From this hospital and literature review, the authors were able to make the following conclusions: (1) the newer acylaminopenicillins exhibited similar activity against common clinical pathogens and were microbiologically more active than the carboxypenicillins; (2) none of these antibiotics used alone appears adequate for empiric treatment of serious systemic gram-negative bacillary infections; (3) the extended-spectrum penicillins were prescribed in a similar fashion and usually in conjunction with an aminoglycoside; and (4) significant cost savings can be realized when less expensive drugs are used. The authors found only minor differences in microbiologic activity and clinical use among the newer extended-spectrum penicillins. Therefore, they recommend the least expensive drug for routine use in the hospital.
Insights
Extended-spectrum penicillins, including newer acylaminopenicillins, show similar efficacy but varying costs. For routine hospital use, selecting the least expensive option is recommended to realize significant cost savings.
Area of Science:
- Pharmacology
- Microbiology
- Health Economics
Background:
- Extended-spectrum penicillins, such as acylaminopenicillins and carboxypenicillins, are used for bacterial infections.
- Acylaminopenicillins may offer therapeutic advantages but are more costly than carboxypenicillins.
Purpose of the Study:
- To compare the microbiologic activity, utilization, and cost of extended-spectrum penicillins in a community hospital setting.
- To guide antibiotic formulary decisions based on local susceptibility patterns and economic factors.
Main Methods:
- Conducted a literature review of extended-spectrum penicillins.
- Performed a microbiologic, utilization, and cost analysis within a community hospital.
- Evaluated activity against common clinical pathogens and empiric treatment adequacy.
Main Results:
- Newer acylaminopenicillins demonstrated comparable activity against common pathogens and were microbiologically superior to carboxypenicillins.
- No single extended-spectrum penicillin was deemed adequate alone for empiric treatment of serious gram-negative infections.
- These penicillins were often prescribed with an aminoglycoside, with similar prescribing patterns observed.
Conclusions:
- Minor differences in microbiologic activity and clinical use exist among newer extended-spectrum penicillins.
- Cost-effectiveness is a crucial factor in selecting antibiotics for hospital formularies.
- Recommends using the least expensive extended-spectrum penicillin for routine hospital use to achieve significant cost savings.