Evolution of Antibiotic Use and Cost in Patients with Community-Acquired Pneumonia

To investigate the evolution and efficiency of the clinical management (particularly shift therapy) of patients with community-acquired pneumonia (CAP) in a hospital setting.

This was a retrospective analysis of 120 hospitalised patients who were treated with antibiotics for CAP in the first semesters of 1999 (50 patients), 2000 (39 patients) and 2001 (31 patients). We evaluated the prescribed daily dose and the average hospitalisation and treatment periods for each drug. Pareto curves were used to examine relative costs and quantities of drugs administered. Total therapy costs and average cost for an antibiotic were also calculated.

Over the 3 years, the drugs most commonly used were ceftriaxone and ciprofloxacin; levofloxacin, introduced in 2001, allowed for shorter average treatment periods. Twenty-one of 39 (53.8%) patients seen in the first semester of 2000 were discharged early compared with 29 of 31 (93.54%) in 2001. Therapy was continued at home (shift therapy) with ciprofloxacin (n = 8), ceftriaxone (n = 5) and cotrimoxazole (n = 2) in 2000 and with ceftriaxone (n = 15), oral ciprofloxacin (n = 7) and oral levofloxacin (n = 7) in 2001.

Shift therapy using either oral or injectable antibiotics is possible in patients with CAP and allowed us to realise significant savings in management. Selection of route of administration of shift therapy should be made on an individual basis.