Related Experiment Videos
Cost and dosing issues
1Infection and Immunodeficiency Unit, King's Cross Hospital, NHS Trust, Dundee, UK.
Abstract:
Twice-daily dosing is recommended for ciprofloxacin for most indications. Trovafloxacin and grepafloxacin can be administered once-daily. Levofloxacin should probably be administered twice daily in serious, life-threatening infections. The acquisition cost of ciprofloxacin is currently higher than the newer agents, but a lower acquisition cost does not necessarily mean a lower overall cost of treatment. A cheaper agent which is less effective or safe just shifts costs to other areas by creating further clinical problems with their attendant costs. The total costs associated with treatment with newer agents are as yet undefined. Restricting the prescription of a particular antibiotic may result in the increased use of an alternative regimen which may cost the same or even more than the original ('cost shifting'). This interesting observation needs to be substantiated with future research. Ciprofloxacin is available in both intravenous and oral formulations and suitable for sequential intravenous-oral therapy with its attendant benefits. It is currently the gold-standard quinolone in the hospital setting for a broad range of infections, particularly Pseudomonas aeruginosa infections. Initially, the newer quinolones are most likely to be used to treat severe, community-acquired pneumonia.
Insights
Ciprofloxacin is the gold-standard quinolone for many infections, though newer agents offer different dosing. Overall treatment costs, including potential
Area of Science:
- Pharmacology
- Infectious Diseases
- Health Economics
Background:
- Ciprofloxacin is the established standard for many infections, with twice-daily dosing.
- Newer fluoroquinolones like trovafloxacin and grepafloxacin offer once-daily dosing options.
- Levofloxacin may require twice-daily dosing for severe infections.
Purpose of the Study:
- To compare the dosing, cost-effectiveness, and clinical utility of ciprofloxacin versus newer fluoroquinolone agents.
- To explore the concept of 'cost shifting' when restricting antibiotic prescriptions.
Main Methods:
- Comparative analysis of antibiotic dosing regimens.
- Review of acquisition costs versus potential overall treatment costs.
- Discussion of clinical applications and emerging trends in fluoroquinolone use.
Main Results:
- Ciprofloxacin, while having a higher acquisition cost, remains the gold standard for many infections, including Pseudomonas aeruginosa.
- Newer agents offer simplified dosing (once-daily), but their total treatment costs are not yet fully defined.
- Cost shifting may occur, where restricting one antibiotic leads to increased use of equally or more expensive alternatives.
Conclusions:
- The overall cost-effectiveness of newer fluoroquinolones requires further research.
- Ciprofloxacin's broad utility, IV/oral formulations, and established efficacy solidify its role in hospital settings.
- Newer quinolones are likely to be initially adopted for severe community-acquired pneumonia.