Cost effectiveness of quinolones in hospitals and the community

In hospitals, oral quinolone therapy has lower daily associated costs (acquisition and administration) than most intravenous regimens. In addition, oral switch therapy shortens the duration of hospital stay for most patients. However, randomised trials are required to measure the economic impact of the switch to oral therapy in terms of hospital care costs and the burden imposed on community health services, on relatives or carers and on the patient. Evidence about the reliability of absorption of quinolones in hospitalised patients is more likely to be obtained from large population kinetic studies than randomised effectiveness trials. The existing literature on cost effectiveness of quinolones in the community is disappointing. The principal problems are poor definition of diagnostic criteria, inclusion of irrelevant comparator drugs and a failure to include infections caused by bacteria that are resistant to the comparator. Consequently, there is little evidence to support the use of economic models to determine the consequences of antibiotic resistance in the community.