A clinical and economic study of community-acquired pneumonia between single versus combination therapy
Mohamed Azmi Ahmad Hasali1, Mohamed Izham Mohamed Ibrahim, Syed Azhar Syed Sulaiman
1School of Pharmaceutical Sciences, universiti Sains Malaysia, 11800, Penang, Malaysia. mizham@usm.my
Insights
For pediatric community-acquired pneumonia (CAP), ampicillin monotherapy is more cost-effective than combination therapy with gentamicin. This approach reduces treatment costs and potential adverse effects in children.
Area of Science:
- Pediatric infectious diseases
- Clinical pharmacology
- Health economics
Background:
- Pneumonia is a major cause of child mortality in developing nations, accounting for millions of deaths annually.
- Acute respiratory infections, primarily pneumonia, are a significant global health concern for children under five.
Purpose of the Study:
- To evaluate antibiotic therapy outcomes for pediatric community-acquired pneumonia (CAP).
- To perform a cost-effectiveness analysis comparing ampicillin monotherapy with ampicillin-gentamicin combination therapy.
Main Methods:
- A prospective, randomized, controlled, single-blind study in a district hospital pediatric ward.
- 40 pediatric patients (2 months-5 years) with CAP were randomized into two groups: ampicillin alone or ampicillin plus gentamicin.
- Clinical and economic evaluations compared treatment effectiveness and costs.
Main Results:
- Significant differences (P < 0.05) were observed between treatment groups in ampicillin duration, hospitalization length, and time to oral switch.
- The ampicillin monotherapy group demonstrated lower overall costs per patient.
- No significant improvement in treatment outcome was found with the addition of gentamicin.
Conclusions:
- Ampicillin monotherapy is a cheaper treatment option for pediatric CAP compared to combination therapy with gentamicin.
- Adding gentamicin increases treatment costs without improving therapeutic outcomes or reducing adverse effects.
- Simplifying antibiotic regimens to ampicillin alone can be more economical and safer for pediatric CAP management.
Background:
Pneumonia is one of the leading causes of morbidity and mortality among children in many developing countries. It is reported that 12.9 million children under 5 years of age died world-wide in 1990 and one-third of these deaths or 4.3 million annually were attributed to acute respiratory infection with pneumonia.
Objectives:
On this basis, a study was conducted in a district hospital to study the therapy outcomes of antibiotic regimens used in pediatric community-acquired pneumonia (CAP) management and to conduct a cost-effectiveness analysis (CE) between IV ampicillin versus combination therapy of IV ampicillin and IV gentamicin.
Method:
A prospective, randomized, controlled, single blind study was conducted in a pediatric ward in a 80-bed district hospital. Pediatric patients diagnosed with CAP aged 2 months to 5 years old were randomly and equally divided into two treatment arms: ampicillin versus ampicillin plus gentamicin. The dose of IV ampicillin used in this study was 100 mg/kg/day divided every 6 h and 5 mg/kg of IV gentamicin as a single daily dose. Both clinical and economic evaluations were carried out to compare both treatment arms.
Results:
With the inclusion and exclusion criteria, only 40 patients diagnosed with CAP were included in the study. The results showed that the two treatment arms were significantly different (P < 0.05) in terms of duration of patients on ampicillin, number of days of hospitalization and time to switch to oral therapy. A significant difference was noted between the two treatment modalities in terms of effectiveness and cost (P < 0.05).
Conclusion:
Overall, the endpoint of this study showed that the total cost per patient of ampicillin-treated group is cheaper than the total cost with the combination therapy (ampicillin plus gentamicin) and reduced unnecessary exposure to adverse effects or toxicities. Besides that, addition of gentamicin in the treatment modalities will only increase the cost of treatment without introducing any changes in the treatment outcome.
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